Utility of aqueous PCR in HIV/AIDS with atypical posterior/panuveitis
Purpose
Ocular inflammation in HIV/AIDS can be due to opportunistic infections(OI), drugs, HIV or immune recovery uveitis(IRU). Atypical manifestations leads to diagnostic dilemma. To evaluate utility of polymerase chain reaction(PCR) of aqueous in diagnosis and management of presumed infectious uveitis in HIV/AIDS patients with atypical posterior/panuveitis
Methods
Retrospective analysis of clinical characteristics, lab results and outcome of HIV patients seen between 2010-2019 with atypical posterior/panuveitis, who underwent PCR analysis of aqueous aspirate at a tertiary care eye hospital. Patients with classical clinical presentations-excluded
Results
Thirty seven patients-included. Two patients with hypopyon uveitis were managed as immune recovery uveitis(IRU) and rifabutin induced uveitis after PCR ruled out infection. In 12 patients with clinical suspicion of CMV retinitis, PCR-CMV positive in 7(59%). In 9 patients with panuveitis. PCR-VZV positive in 3(33%), PCR-CMV in 2 and PCR negative in 4(serology and systemic results confirmed ocular syphilis in 3 and tuberculosis(TB) in 1). In 3 patients with clinical diagnosis of toxoplasmosis, PCR-toxoplasma gondii positive in 1. In 4 patients with presumed ocular TB, PCR-MTB positive in 1. With adjunctive use of PCR, serology and systemic results, confirmed diagnosis was made in 84% patients. Modified therapy translated into improved/stable vision in 62%
Conclusion
Ocular inflammation with atypical presentations, clinical features alone is insufficient. PCR of aqueous helps clinch diagnosis. Appropriate management leads to improved inflammatory and visual outcome avoiding unnecessary surgical intervention
Conflict of interest
No
Author 1
Last name
SRIDHARAN
Initials of first name(s)
S
City
Chennai
Country
India
Author 2
Last name
Mohanan
Initials of first name(s)
A
City
Chennai
Country
India
Author 3
Last name
Dhanurekha
Initials of first name(s)
L
City
Chennai
Country
India
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