The presence of HIV infection in a hospital-based primary care setting

Background: The incidence of HIV infection in the general population continues to grow as a cure is yet to be found. Fortunately, great strides have been made in treating this multifactorial disease so patients are living longer and more productive lives. As a result, there is a growing demand from all health care disciplines, including optometry, to provide care for patients with HIV infection. Methods: From June 1, 1994 through May 30, 1995, HIV seropositive patients presenting to the primary care optometry clinic at the Bascom Palmer Eye Institute were identified from the total clinic population. All patients presented to the clinic as part of a routine eye exam or were referred by a primary physician. All abnormal findings were recorded in a log in addition to the CD4+ T-cell count. Results: One hundred and fifty HIV seropositive patients were identified from the clinic population. Fifty percent were ocularly abnormal including 31 patients (20.7%) with HIV microangiopathy, and nine patients (6%) with CMV retinitis. One hundred and eighteen patients (78.7%) knew their CD4 count. There was a correlation between HIV-related ocular findings and low CD4 counts. Similarly 65.6% of the patients who did not know or did not share their CD4 counts had abnormalities in their eye exam with 52.4% being HIV related. Conclusion: Optometrists play an important part of the health care team since patients with HIV infection present to primary care optometrists for comprehensive eye care as demonstrated in this study. The optometrist must be aware of the status of their CD4 count as this helps determine the risk for having HIV-related problems. Many patients will be able to provide this information as shown. Caution must be displayed with patients who do not know their CD4 count as this may be a poor prognostic sign. Finally, optometrists must educate patients about the risk for developing ocular complications from HIV as part of their eye care as both HIV microangiography and CMV retinitis were the most common AIDS-related ocular findings.