Posterior segment manifestations in human immunodeficiency virus/acquired immunodeficiency syndrome patients in rural population of central india

Gaurav Agrawal, Meenu Babber, Ifsa Sami, Reena Sharma, Ravi Ranjan


Background: Ocular manifestations of HIV infections are common in the developing countries with lacking data in rural areas. The aim of study was to assess the prevalence of ophthalmic manifestations among HIV infected individuals in rural population and to find the relationship between CD4 count and ocular manifestations among these individuals.

Methods: Authors have included 400 HIV patients of age more than 15 years that were registered in ART center of our institute. Ocular examination was done with slit lamp biomicroscope and indirect ophthalmoscope. Blood sample was sent for CD4 count analysis.

Results: The mean age of patients ware 31.9±9.3 years, the ocular manifestations were more commonly found in the age group 25-35 years. 51 % were males and 49% were females. Most common mode of transmission was heterosexual contact (51%).55 % patients had CD4 count >150 cell/cumm. Cotton wool spots (36%) and intra-retinal haemorrhages (32%) was most common posterior segment findings followed by ocular toxoplasmosis (13%), CMV retinitis (10%), acute retinal necrosis (3 %).

Conclusions: The prevalence of ocular manifestations in HIV patients is high and is a burden for our society, authors recommend screening of all the HIV patients to detect any vision threatening ocular lesions at the earliest.


Cotton wool spots, HIV retinopathy, Intra-retinal haemorrhage

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National AIDS control organisation. Overview of HIV epidemic in India: Annual report 2015-2016. 2015:335-7. Available at:

Gottlieb MS, Schroff R, Schanker HM, Weisman JD, Fan PT, Wolf RA, et al. Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: evidence of a new acquired cellular immunodeficiency. New Eng J Med. 1981;305(24):1425-31.

Centres for Disease Control and Prevention. Update: Acquired immunodeficiency syndrome-United States, 1992. MMXVR. 1993;42:547-551. Available at:

Banker AS. Symposium on posterior segment manifestations of human immune deficiency virus and acquired immune deficiency syndrome. Indian J Ophthalmol. 2008;56:377-83.

Biswas J, Madhavan HN, George AE, Kumarasamy N, Solomon S. Ocular lesions associated with HIV infection in India: a series of 100 consecutive patients evaluated at a referral center. Am J Ophthalmol. 2000;129(1):9-15.

Sharma M, Chauhan A, Sharma G, Chauhan V. Ocular manifestations in patients attending antiretroviral therapy centre at a tertiary care hospital in Himachal Pradesh, India. Indian J Med Res. 2018;147(5):496.

Gogri PY, Misra SL, Kothari RN, Bhandari AJ, Gidwani HV. Ophthalmic manifestations of HIV patients in a rural area of western Maharashtra, India. Int Schol Res Notic. 2014;2014.

Sahu DK, Namperumalsamy P, Walimbe P, Rajalakshmi C. Ocular manifestations of HIV infection/AIDS in South Indian patients. Indian J Ophthalmol. 1999;47(2):79.

Sharma RL, Panwar P, Gupta R, Sharma A, Chaudhary K. Ocular manifestations in human immunodeficiency virus/acquired immuno deficiency syndrome patients and their correlation with CD4+ T-lymphocyte count. Annals Trop Med Public Health. 2012;5(5):474.

Nishijima T, Yashiro S, Teruya K, Kikuchi Y, Katai N, Oka S, et al. Routine eye screening by an ophthalmologist is clinically useful for HIV-1-infected patients with CD4 count less than 200/μL. PloS One. 2015;10(9):e0136747.

Kumar P, Vats DP, Mishra S, Makkar A, Banarji A, Patyal S, et al. CD4 counts: a strong indicator of retinal and ocular lesions in HIV disease. Med J Arm Forc India. 2011 Oct;67(4):354.