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Ocular disease in children with vertically acquired human immunodeficiency virus infection
P G Livingston1, N C Kerr, J L Sullivan
1University of South Florida, Tampa, USA.
Insights
Ocular disease is less common in children with vertically acquired human immunodeficiency virus (HIV) infection compared to adults. Close monitoring for cytomegalovirus retinitis is crucial in children with advanced HIV disease and low CD4 counts.
Area of Science:
- Pediatric Ophthalmology
- Infectious Diseases
- Immunology
Background:
- Clinical observations indicate distinct ocular disease patterns in vertically HIV-infected children versus adults.
- Limited literature exists on AIDS-related ophthalmic disease incidence in pediatric HIV.
- Advancements in treatment allow pediatric AIDS patients to live longer, necessitating updated ocular disease understanding.
Purpose of the Study:
- To investigate the incidence and characteristics of ocular disease in vertically HIV-infected children.
- To compare ophthalmic findings in symptomatic versus asymptomatic pediatric HIV infection.
- To identify risk factors for AIDS-related ophthalmic complications in children.
Main Methods:
- Prospective follow-up of 33 culture-positive, vertically HIV-infected children.
- Regular ophthalmic examinations conducted over a 5-year period.
- Categorization of patients based on symptomatic/asymptomatic HIV disease and CD4 counts.
Main Results:
- Ophthalmic findings were observed in 10 out of 33 children.
- 50% of symptomatic AIDS patients developed ocular findings, compared to one asymptomatic patient.
- Cytomegalovirus retinitis occurred in two patients with CD4 counts below 10.
Conclusions:
- AIDS-related ophthalmic disease appears less frequent in vertically infected children than in adults.
- Intensified clinical surveillance for cytomegalovirus retinitis is recommended for children with end-stage HIV and very low CD4 counts.
Background:
Clinical reports suggest that ocular disease in infants and children vertically infected with human immunodeficiency virus (HIV) is different from that in adults. Pediatric patients with acquired immunodeficiency syndrome (AIDS) and HIV infection are being treated more aggressively and are living longer, but current literature on the incidence of AIDS-related ocular disease in vertically acquired HIV infection is limited.
Methods:
Thirty-three children with culture-positive, vertically acquired HIV infections were prospectively followed with ophthalmic examinations between September 1991 and August 1996 at the University of Massachusetts. Patients were categorized as having symptomatic or asymptomatic HIV disease according to the U.S. Centers for Disease Control and Prevention guidelines. Absolute CD4 counts and other measures of immune function were obtained.
Results:
The average length of follow-up was 30 months, and the average number of ophthalmic examinations per patient was 4.8. Ten patients developed ophthalmic findings. Nine of 18 (50%) patients with symptomatic AIDS disease developed ophthalmic findings. One of 15 asymptomatic HIV-infected patients developed ocular findings. Two patients with absolute CD4 counts less than 10 developed cytomegalovirus retinitis.
Conclusions:
These results suggest that AIDS-related ophthalmic disease is less common in vertically infected children than in adult AIDS patients. It also supports intensified clinical surveillance for cytomegalovirus retinitis in children with end-stage disease and very low CD4 counts.