Title : Clinical and etiological features of infectious uveitis in HIV-positive and HIV-negative patients in the department of internal medicine
Introduction: Uveitis is an inflammation of the uvea, intraocular, of heterogeneous etiology and presentation. The aim of our study is to describe the clinical and therapeutic features of infectious uveitis in HIV+ and HIV- patients.
Patients and methods: This is a retrospective study carried out in the internal medicine department of CHU Ibn Sina in Rabat over a 13-year period (2010-2022), involving 42 cases of infectious uveitis.
Results: 42 patients were enrolled. 34% (14 cases) had acquired immunosuppression (9 cases: 22% had HIV infection and 12% were on chemotherapy) and 66% were immunocompetent. The sex ratio M/F was 1.1. Mean age was 39 years. Uveitis revealed HIV in only one case, 8/9 patients were previously followed-up, their mean viral load: 3.4 log and mean CD4 count: 356/mm3. Revealing functional signs were: ocular redness (27%), decreased visual acuity (63%), visual blur (40%), ocular pain (18%), scotoma (13%), headache (4%). The sites of uveitis were: anterior (30%), intermediate (6%), posterior (32%) and pan-uveitis (32%); unilateral in 80% of patients and bilateral in 20%. The etiologies of uveitis in HIV+ patients were: 3 cases of CMV, 2 cases of toxoplasmosis, 1 case of tuberculosis, 1 case of HSV, 1 case of VZV and one case of syphilis. Etiologies of immunocompetent patients: tuberculosis (41%), toxoplasmosis (18%), syphilis (15%), CMV infection (4 cases: 10%), HSV infection (4 cases: 10%), lepromatous uveitis (1 case: 2%), VZV infection (1 case: 2%), a locoregional infectious cause such as dental abscess (1 case: 2%), and a case of borreliosis (3%). 50% of tuberculosis uveitis cases were of the pan-uveitis type, while 75% of toxoplasmosis uveitis cases were of the posterior type. Uveitis was associated with other pathologies in 2 seropositive cases (cerebral vasculitis, multifocal tuberculosis). Specific treatment was prescribed for all patients. The initial course was favorable in 57%, 12% of whom were HIV+. 14% (6 cases) presented relapses of the same site during toxoplasmic, tubercular and herpetic uveitis. 47% presented complications, of which 4 patients were HIV+: 4 retinal detachments; 8 retinal hemorrhages. 14% (6 cases) unilateral blindness (including 2 HIV+ patients). No patient presented a locoregional ENT infection, sepsis or death.
Conclusion: In our series, the etiologies of infectious uveitis differed between HIV+ and HIV- patients. HIV+ patients most often had toxoplasmosis and CMV, whereas HIV- patients mainly presented with tuberculosis and toxoplasmosis. The association between HIV and uveitis is undetermined, but HIV infection was an independent risk factor for uveitis.