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Retinal manifestations of HIV-1 and HIV-2 infections among hospital patients in The Gambia, West Africa

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Summarybackground In developed countries, 50–75% of AIDS patients develop retinal complications and about 20–40% acquire cytomegalavirus (CMV) retinitis. We conducted a cross-sectional survey to determine prevalence of these in The Gambia where both HIV-1 and HIV-2 infection are present and the prevalence of HIV-1 is rising.

method All patients attending hospital whose percentage CD4 + cells (CD4%) was below 14, the level associated typically with an AIDS diagnosis, and one half of those whose CD4% was 14 or above were asked to join the study. Fifty-six HIV-1, 52 HIV-2 and 12 dually infected patients were recruited. Photographs of the fundi were taken and interpreted independently. The findings were related to the patients' percentage CD4 + cells.

results The CD4% was < 14 in 40 patients and < 7 in 17 patients. Thirty-six patients were male. No cases of CMV retinitis were found. Four patients whose CD4% were 4, 5, 11 and 23 had cotton wool spots ranging in number from 1 to 14 for any one patient. The prevalence of cotton wool spots was 8% (95% CI, 0–16%) among patients with CD4% below 14 and 12% (95% CI, 0–27) among patients with CD4% below 7. One of the 4 patients had associated microaneurysm and blot haemorrhages typical of more advanced HIV microvasculopathy.

conclusion CMV retinitis is less common in The Gambia than in developed countries. Non-infectious retinopathy may also be less common.
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Keywords: CMV retinitis; HIV-1; HIV-2; The Gambia; retinal manifestations

Document Type: Research Article

Affiliations: 1: Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK 2: Medical Research Council Laboratories Fajara, Banjul, The Gambia 3: The Eye Department, University College Hospitals, Cleveland Street, London, UK 4: National Eye Care Programme, Department of State for Health and Social Welfare, Eye Unit, Royal Victoria Hospital, The Gambia 5: Institute of Ophthalmology, London, UK

Publication date: 01 July 1999

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