To study clinical profile and management outcome of ocular syphilis in HIV/AIDS patients in the HAART era
Methods
Retrospective study. Included-HIV/AIDS patients with syphilis coinfection seen between 2013-2018 in tertiary eye hospital-min-6 month follow-up. Ophthalmic/systemic examination/investigation details and management outcome analysed
Results
30 patients(50 eyes, 20-bilateral)(males-28, females-2, age range 24–60 years) included. Mean duration-HIV diagnosis to ocular presentation-15.95 months. 8 patients were detected with HIV while investigating for ocular disease. CD4 counts range-42-612cells/cu.mm. Heterosexual-18(males-16,females-2), bisexual-3 and men having sex with men(MSM)–9. Ocular manifestations-panuveitis-commonest-25 eyes, posterior uveitis-14 eyes(retinitis–10, choroiditis-2, vasculitis-2), vitritis-6 eyes, anterior uveitis-4 and atypical optic neuritis-1 eye. Retinitis seen in patients with CD4<100 and placoid choroiditis in CD4>600. Significant inflammation noted despite low CD4 counts(150-300). CSF confirmed neurosyphilis-3 patients. Median RPR titre-1:32, median TPHA-1:1280. All patients treated with HAART, systemic penicillin and steroids. Four patients with recurrences(>6 weeks) and 2 with IRU were retreated with long term penicillin and systemic steroids respectively. At final follow-up, all had reduced titres and inflammation control. Vision improved/stable-38 eyes-mean logMAR-1.205 improving to 0.63
Conclusion
Panuveitis, presenting feature in 50%.MSMs higher risk. Atypical retinitis, mimics CMV. IRU, uncommonly can present as CME. HAART, systemic penicillin helps prevents systemic infection and recurrence
Conflict of interest
No
Author 1
Last name
SRIDHARAN
Initials of first name(s)
S
City
Chennai
Country
India
Author 2
Last name
Menia
Initials of first name(s)
N
City
Chennai
Country
India
Author 3
Last name
Tyagi
Initials of first name(s)
M
City
Hyderabad
Country
India
Author 4
Last name
Biswas
Initials of first name(s)
J
City
Chennai
Country
India
Author 5
Last name
Therese
Initials of first name(s)
L
City
Chennai
Country
India
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