AIDS affects blindness prevention efforts in poor countries

The spread of AIDS in sub-Saharan Africa has had a “tremendous impact” on health care in general and eye health care services in particular, according to a physician based in Tanzania. More research is needed to evaluate the impact of HIV and AIDS on blindness prevention efforts and eye health care delivery in the region, said Susan Lewallen, MD, of the Kilimanjaro Centre for Community Ophthalmology.

An editorial by Dr. Lewallen in the Journal of Community Eye Health describes the impact of AIDS on ocular health care in sub-Saharan Africa. She said the AIDS epidemic directly and indirectly affects the delivery of eye health services. One of the direct effects is the development of the disease among eye care workers themselves.

“Given the shortage of trained personnel, a single death can have a major impact on a program,” Dr. Lewallen said.

Regarding ocular complications and diseases experienced in the region, herpes zoster ophthalmicus (HZO) infection is a dramatic complication of AIDS, Dr. Lewallen said, although the problem may not be as great as initially imagined. Estimates suggest that 40 to 60 cases of the HZO would be encountered in a severely affected urban area in a year, she said.

Kaposi’s sarcoma and squamous cell carcinoma are also prominent complications of AIDS, with as much as a sixfold increase in conjunctival squamous cell tumors reported in some centers during the 1990s.

Dr. Lewallen noted that operating records at the Queen Elizabeth Central Hospital in Blantyre, Malawi, show a tenfold increase in the removal of conjunctival tumors between 1989 and 2002. She said there has been a general impression that such lesions may be more aggressive in African patients with HIV, but “the epidemiological picture remains unclear.”

The incidence of cytomegalovirus retinitis is low in sub-Saharan Africa in contrast to Western countries and does not currently constitute a major healthcare burden, Dr. Lewallen said. However, increased availability of highly active antiretroviral therapy (HAART) could change this picture, as patients would live longer with the disease, she said. Proper use of HAART would also likely decrease the incidence of ocular complications associated with HIV and AIDS overall, she said.

“Even this situation, alarming as it sounds, would be unlikely to change the magnitude of blindness in sub-Saharan Africa. Cataract, childhood blindness, trachoma, and granuloma will still be responsible for most of the blind-person years,” Dr. Lewallen said.

“The final toll of the epidemic on eye care services and prevention of blindness work remains to be seen. We would do well to gather more information and consider these issues in planning our programs,” she said.