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Year : 2002  |  Volume : 50  |  Issue : 2  |  Page : 80-81

Acquiring skills in management of HIV-related and other newer infections of the eye

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S Jalali

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PMID: 12194583

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How to cite this article:
Jalali S. Acquiring skills in management of HIV-related and other newer infections of the eye. Indian J Ophthalmol 2002;50:80-1

How to cite this URL:
Jalali S. Acquiring skills in management of HIV-related and other newer infections of the eye. Indian J Ophthalmol [serial online] 2002 [cited 2020 Oct 20];50:80-1. Available from: https://www.ijo.in/text.asp?2002/50/2/80/14794

As physicians and scientists we need to be aware of newer, commonly occurring clinical entities and keep ourselves up to date on various aspects of such disorders. Virus infections of the retina and HIV-related infections of the eye are not uncommon in India. Yet many ophthalmologists are probably not aware of the clinical presentations of these entities. Two articles in this issue, by Biswas et al[1] and Wagle et al[2] discuss two important virus infections that can have predominantly retinal manifestations though other ocular tissues can also be involved. To avoid blindness from such newer virus-related disorders, there is a need for precise diagnosis and institution of specific treatment. Currently, to my knowledge only a few centers have developed this expertise. This need not be so as antiviral drugs are widely available, and sufficiently backed up by international medical literature.

CMV retinitis has classical clinical manifestations. It should not be difficult to diagnose especially in immunosuppressed individuals. Vigorous and early treatment in consultation with the primary physician (nephrologist or internist) can salvage useful vision in many of these patients. Anti-CMV drugs such as Gancyclovir, Foscarnet, etc are widely available and experience amongst internists in the use of these drugs is increasing. What is needed is familiarity with the disease manifestations and management protocols.

HIV infection is so rampant in India that no physician can escape handling such patients. While all of us should try to educate the public to prevent HIV infection, excluding infected individuals from treatment is not the solution. In fact knowing that a patient has HIV is easier to handle as everybody is on guard. But, when a patient walks into the clinic and undergoes evaluation, he/she does not carry the label of HIV infection. In some cases even screening for HIV may not detect the latent virus in the human blood. Hence, there is a need for implementing universal hygiene measures and precautions. These measures unfortunately are 'universally ignored'.[3] Though the HIV virus does not survive for long outside the human body, there are numerous reports of transmission of infection to health care workers.[4] This is to be avoided at all costs. Hand washing and avoiding direct contact with any body fluids is a simple precaution that should be a routine practice in all clinics. Proper disposal of sharp instruments including needles is mandatory for all health personnel.

The AIDS epidemic is increasingly affecting the practice of ophthalmology, both in terms of safety precautions and disease presentation. The safety precautions include education of all health care personnel, resources to obtain disposable materials, setting up systems for proper disinfection/disposal of contaminated materials, eye bank tissue surveillance, reporting lapses, and quality control monitoring. If these procedures are not planned and implemented by all professionals involved in patient care, transmission of HIV infection between patients and staff or between two patients undergoing treatment for eye ailments, will be rampant.

Common ocular manifestations of HIV infection in India are marginally different from those reported in the West; for example, ocular tuberculosis may be more common while Kaposi's sarcoma is not yet reported. Over the past decade, we as clinicians have just begun to learn how to diagnose and manage new entities of ocular lesions in HIV infection. The recent introduction of highly active anti-retro viral therapy (HAART) for HIV in India is likely to change the disease manifestations. We are likely to see newer entities like immune recovery vitritis and newer treatment protocols.. This underlines the need to stay at the cutting edge of knowledge of newer disease entities.

Two steps that I would consider important are (a) improving our diagnostic skills and (b) developing a familiarity with treatment protocols.

It goes without saying, of course, that we do not have any prejudice against HIV infected individuals.

  References Top

Biswas J, Fogla R, Gopal L, Narayana KM, Banker A, Kumarasamy N, et al. Current approaches to diagnosis and management of ocular lesions in Human deficiency virus positive patients. Indian J Ophthalmol 2002;50:83-96.  Back to cited text no. 1
Wagle AM, Biswas J, Gopal L, Madhvan HN. Clinical profile and immunological status of cytomegalovirus retinitis in organ transplant recipients. Indian J Ophthalmol 2002;50:115-21.  Back to cited text no. 2
Hammond JS, Eckes JM, Gomez GA, Cunningham DN. HIV, trauma and infection control: universal precautions are universally ignored. J Trauma 1990;30:555-58.  Back to cited text no. 3
Ridzon R, Gallagher K, Ciesielski C, Mast EE, Ginsberg MB, Robertson BJ, et al. Simultaneous transmission of human immunodeficiency virus and Hepatitis C virus from a needle-stick injury. NEJM 1997;336:919-22.  Back to cited text no. 4


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