Grand Rounds - HIV/AIDS Patients

[Richard_Hom]

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Dear 3rd year, 4th year and residents in optometry:

1. A 51 year old male whose pretreatment absolute CD4 is 50 and after 2months of treatment it is now 600. Viral load now undetectable. If you see normal retina, when would you return the patient?

2. A 51 year old male whose pretreatment absolute CD4 is 5 and after 2 months of medical treatment it is now 300. Viral load undectable. If you see normal retina, when would you return the patient?

3. A 51 year old male whose pretreatment CD4 is 400, on medical treatment with no change on absolute CD4 and you see multiple CWS with flame shaped hemorrhages, when would you return the patient?

4. A 51 year old male whose pre-treatment absolute CD4 is 5, on medical treatment, with no change in absolute CD4 and you see multiple CWS with flame-shaped hemorrhages, when would you return the patient?

 

[Richard_Hom]

This photo is for the posted scenario above.

 

[Andrew_Doan]

1. A 51 year old male whose pretreatment absolute CD4 is 50 and after 2months of treatment it is now 600. Viral load now undetectable. If you see normal retina, when would you return the patient?

If vision is stable, then I would bring back in 3-4 months. If stable then, then double the interval.

2. A 51 year old male whose pretreatment absolute CD4 is 5 and after 2 months of medical treatment it is now 300. Viral load undectable. If you see normal retina, when would you return the patient?

If vision is stable, then I'd bring the patient back in 2-3 months. If stable then, then double the interval.

3. A 51 year old male whose pretreatment CD4 is 400, on medical treatment with no change on absolute CD4 and you see multiple CWS with flame shaped hemorrhages, when would you return the patient?

If these retina findings are new, then it could either be HIV retinopathy after reconstitution of his immune system, CMV, or other infectious cause. I would bring the patient back in 1-2 weeks. If stable, then 1 month. Then doubling the interval if retina findings resolve or remain stable.

4. A 51 year old male whose pre-treatment absolute CD4 is 5, on medical treatment, with no change in absolute CD4 and you see multiple CWS with flame-shaped hemorrhages, when would you return the patient?

This could be HIV retinopathy. Could be infectious etiology too, but now he may not be mounting an immune response with a low CD4. Bring him back in 1 week and follow closely.

You'd want to screen for all treatable causes of retinopathy if he worsens: syphillis, TB, lyme, toxo, CMV, herpes etc...

These CWS and retinopathy may be related to his retroviral therapy.