Microbial keratitis in patients infected with the human immunodeficiency virus

Posterior segment complications of systemic infection with the human immunodeficiency virus (HIV) are well recognized. The anterior segment complications often are, however, overlooked. The author treated 20 episodes of nonherpetic infectious keratitis in 17 eyes of 13 patients infected with HIV who presented between August 1990 and May 1994.

Review of records.

Nine patients were women, and four were men. Mean age was 35.2 years. The keratitis was bilateral in four patients, polymicrobial in four, and recurrent in two. The most common infecting organism was Candida albicans (5 eyes), a rare cause of keratitis in immunocompetent individuals. Other organisms included Staphylococcus aureus in four eyes, Staphylococcus epidermidis in four, Bacillus sp in two, and one each Pseudomonas aeruginosa, alpha-hemolytic Streptococcus, Micrococcus sp, and Capnocytophaga sp. Seven eyes retained 20/30 or better visual acuity after treatment, eight had visual acuity of 20/50 or worse, and two were eviscerated. Classic predisposing factors for infectious keratitis were found in only two patients and included contact lens wear and atopy in one patient each. Twelve patients had a history of intravenous drug abuse.

Infectious keratitis should be recognized as a complication of systemic HIV infection, especially in the context of drug abuse. The prognosis for recovery of vision in these patients often is poor.