Case Study #2

HIV/AIDS
By Cassie, Eric, Corom,
Andy, and Nikki
Overview
-Define HIV/AIDS
-Ocular manifestations/treatments
-Infection Control/Procedures
-Treatment/HAART
-Transmission of HIV and Viral Load/CD4 count
-Patient History
-Summary
Definitions
Definition: HIV
Dictionary:
1. stands for Human Immunodeficiency Virus
2. cause of AIDs

A virus that only affects humans and that its

target the immune system of that individual
Definition: AIDS
Dictionary:
A disease of the immune system by increased
susceptibility to opportunistic infections, to certain
cancers, and to neurological disorders
 HIV? AIDS?

Whats the
difference?
Difference between HIV and AIDS

E
 Ocular
Manifestations
Ocular Manifestations of HIV
HIV Retinopathy
Most common ocular complication of HIV
CD4 Counts less than 100 mm3
Typically wont affect
vision to a degree
that a patient would
notice
Treatment via HAART
Ocular Manifestations of HIV
Cytomegalovirus (CMV) Retinitis
Most common opportunistic infection of the eye
CD4 counts <50 mm3
Patients may present
with floaters/blurred
vision.
Can lead to blindness.
Treated with antiviral
Injections/corticosteroids
Ocular Manifestations of HIV
Adnexal Manifestations
Adnexa of visual system includes; conjunctiva,
lacrimal glands, and eyelids.
Symptom include:
Blepharitis (inflammation)
and sicca syndromes (dry
eye)
Treated with antibiotic
Ocular Manifestations of HIV
Infectious Keratitis
Due to varicella zoster/herpes simplex.
The different forms of herpes
can cause a multitude of
keratitis, as well as other
complications.
Treated with antibiotic/antiviral/
antifungal

N
Infection
Control
Infection Control

Occupational Safety
HAART








Life Style Modification

Modes of HIV Transmission
and Viral Load/CD4 Cell
Count
 Transmission
Sexual Intercourse
Mother to baby
Injections
 Sexual Intercourse
Most common mechanism world-wide
Oral Sex low risk
Females are 8x more efficient to infection
Circumcision reduces rate of HIV transmission by 50%
Presence of other STDs can increase risk
(i.e syphilis, HPV)
 Mother To Baby
Before birth
During delivery
Breast milk
 Injections
IV drug use via needles
Blood transfusion/organ transplant
 Common Misconceptions
HIV not spread by:
Saliva
Water
Blood-sucking Insects (i.e mosquito)
Casual contact
 Phases of Infection
1. Early Acute Phase (Acute retroviral syndrome)
2. Middle, Latency Phase
3. AIDS

Viral Load level of HIV in a drop of blood

CD4 Cell Count amount of CD4 cell in a drop of blood
Viral Set Point relatively stable level of virus in body
c
Clinical Case: HIV Infection

Putting it all together!

 Case History
A 32 year old male presents for evaluation of
reduced visual acuity that has persisted for
the past few months. He also complains of
dry, red eyes.
He just found out that he is HIV positive.
What questions should you ask the patient
about his medical condition?
 What does this mean?
Chief complaint: reduced visual acuity
Associated symptoms: dry, red eyes
PMHx: HIV Positive

Possible DDx: HIV Retinopathy,

Cytomegalovirus Retinitis, Infectious Keratitis
 Subjective Findings (SOAP)
Dont forget SOAP
Entrance tests unremarkable
Best corrected VA (BCVA) 20/25 OD and OS
No improvement in BCVA with refraction
(remember from methods NIPH)
 Objective Findings (SOAP)
Your examination reveals the following findings:
 Assessment (SOAP)
What is the most likely cause of the reduced
visual acuity?
Keratitis HIV Retinopathy
 Plan (SOAP)
What treatment recommendations would you
make, both systemically and optically?
Systemically:

Optically: Treatment via HAART for HIV retinopathy, Treated with

antibiotic/antiviral/ antifungal medications for keratitis

What precautions will you take in treating this

patient?
 Summary
-Define HIV/AIDS
-Ocular manifestations/treatments
-Infection Control/Procedures
-Treatment/HAART
-Transmission of HIV and Viral Load/CD4 count
-Patient History

C, E, N, A, C
References
http://dictionary.reference.com/browse/AIDS

http://www.aids.gov/hiv-aids-basics/just-diagnosed-with-hiv-aids/hiv-in-your-body/stages-of-hiv

http://www.aids.gov/hiv-aids-basics/just-diagnosed-with-hiv-aids/understand-your-test-results/viral-load/

http://www.webmd.com/hiv-aids/hiv-viral-load-what-you-need-to-know

http://www.aids.gov/hiv-aids-basics/hiv-aids-101/how-you-get-hiv-aids/

http://www.aids.org/topics/aids-faqs/how-is-hiv-transmitted/

http://www.aoa.org/Documents/optometrists/QI/hazardous-chemical-exposure-guidelines-for-the-optometric-office.pdf
Questions?