Human immunodeficiency virus and CD4 count in ocular surface squamous neoplasia.
Loading...
Date
2016
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
During my time working at various eye clinics in Kwazulu-Natal, I observed that more often
than not, patients with disfiguring ocular surface squamous neoplasia (OSSN) were Human
Immunodeficiency virus (HIV) positive and generally quite ill, often requiring radical
ophthalmic surgery for the tumour and urgent referral to the local Centre for Disease control
(CDC) and HIV/Acquired Immunodeficiency Syndrome (AIDS) clinics, whereas the patients
with conjunctival intraepithelial neoplasia (CIN) were usually HIV negative or HIV positive but
well looking.
This sparked the question of whether or not there may be a relationship between Cluster of
Differentiation 4: a glycoprotein found on the surface of immune cells (CD4) counts and OSSN
in HIV positive patients and could these findings – should they be in the affirmative – be used as
a CDC case defining criteria for AIDS and streamlet referral of these patients for Highly Active
Antiretroviral Therapy (HAART).
Although HIV/AIDS is a global pandemic and has been linked to OSSN, an extensive literature
search found no studies specifically looking at CD4 counts in these patients. My study titled
“Human Immunodeficiency Virus and CD4 count in ocular surface squamous neoplasia” was
thus born.
I elected to perform my study in two parts. Firstly a prospective descriptive study to determine
the prevalence of HIV in OSSN in my study population from September 2012 to December
2014, and secondly a case control study to determine the odds ratio of CD4 counts in HIV
positive patients with OSSN (cases) and those without OSSN (controls)
I hypothesized that:
1. >50% of patients with OSSN have HIV and
2. At least 90% of HIV patients with OSSN have a CD4 count <350 cells/μl.
It was unfortunate that the number of cases recruited in the given time fell short of the ideal
number required as outlined in my protocol, however a minimum of 3 controls per case (as
opposed to one) all matched for age and gender were selected from the national data base in
order to improve the statistical significance and proceed with the study.
I had hoped that the results from this study could be used to include OSSN as a CDC case
defining condition for AIDS but unfortunately, although illustrative of the possibility, larger
studies will have to be conducted to prove this. I was however, able to achieve the listed aims of
the study and prove both of the hypotheses. It is hoped that in doing so, the holistic management
of these patients with OSSN will be improved with their referral for HIV and AIDS screening
being streamlined and emphasized.
Description
Master of Medical Science in Ophthalmology. University of KwaZulu-Natal. Durban, 2016.