Tear lactoferrin levels and ocular bacterial flora in HIV positive patients

Keratoconjunctivitis Sicca(4) has recently been reported to occur at a greater rate in HIV-positive symptomatic patients. We looked at HIV positive asymptomatic patients, compared to age matched HIV negative patients to study external ocular resistant factors, namely lactoferrin levels in tears, bacterial flora in lid margins, conjunctiva and tears, and evidence of dry eyes using a Schirmer test and tear osmolarity. Eighteen eyes of nine HIV positive patients and eighteen eyes of HIV negative controls were studied. Results showed markedly decreased lactoferrin levels in HIV positive asymptomatic patients with a mean of 85.8 mgs/dcl compared to HIV negative patients with a mean 156 mgs/dcl (P < 0.01). There were increased numbers of colonies of bacterial flora on the lids of HIV positive asymptomatic patients with an average colony count 4.1 colonies/patient compared to 1.5 colonies/patients in the control group (P < 0.025). Seventy eight percent of the study group had bacterial growth compared to 33% in the control group. The tear osmolarity in both groups had no significant difference; mean in HIV positive being 312 mosml/litre; mean in control 306 mosml/litre. The Schirmer test also showed no significant difference, with the mean in HIV positive patients being 11 mm wetting, and in control patients being 12.7 mm wetting. Therefore, despite no symptomatic or clinical evidence of dry eyes, asymptomatic HIV-positive patients had markedly decreased levels of lactoferrin in tears and increased colony counts of bacterial flora in the lids.