MICROBIAL KERATITIS IN PATIENTS INFECTED WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS

Background: Posterior segment complications of systemic infection with the human immunodeficiency virus (HIV) are well recognized. The anter ior segment complications often are, however, overlooked. The author t reated 20 episodes of nonherpetic infectious keratitis in 17 eyes of 1 3 patients infected with HIV who presented between August 1990 and May 1994. Methods: Review of records. Results: Nine patients were women, and four were men. Mean age was 35.2 years. The keratitis was bilatera l in four patients, polymicrobial in four, and recurrent in two. The m ost common infecting organism was Candida albicans (5 eyes), a rare ca use of keratitis in immunocompetent individuals. Other organisms inclu ded Staphylococcus aureus in four eyes. Staphylococcus epidermidis in four, Bacillus sp in two, and one each Pseudomonas aeruginosa, alpha-h emolytic Streptococcus, Micrococcus sp, and Capnocytophaga sp. Seven e yes retained 20/30 or better visual acuity after treatment, eight had visual acuity of 20/50 or worse, and two were eviscerated. Classic pre disposing factors for infectious keratitis were found in only two pati ents and included contact lens wear and atopy in one patient each. Twe lve patients had a history of intravenous drug abuse.Conclusion: Infec tious keratitis should be recognized as a complication of systemic HIV infection, especially in the context of drug abuse. The prognosis for recovery of vision in these patients often is poor.