The Role of Hiv in the Pathogenesis of Adult-Onset Vernal Keratoconjunctivitis: A Demographic and Epidemiological Study

Abstract

Background: Very few studies in the literature describe adult-onset vernal keratoconjunctivitis (VKC). HIV has many associated ocular pathologies and an association with VKC has not been described yet. The aim is to identify and describe patients who present with new-onset VKC after puberty, with no prior history of atopic diseases or allergies. Methods: The study consisted of two parts: the first part was a prospective observational descriptive study of patients with adult-onset VKC, detailing the epidemiological and demographic characteristics of these patients, including their HIV status. The second was a case-control study to determine the relationship of a CD4 count with adult-onset VKC in the setting of HIV. Patients were recruited between January 2016 and November 2017 from McCord Provincial Eye hospital, one of two large referral hospitals for the province of KwaZulu-Natal, South Africa. Patients presenting to the Eye clinic were screened at the Primary Eye Care Unit. Inclusion criteria were age 15 years and older with signs and symptoms of new-onset VKC. Exclusion criteria were a history of childhood atopic diseases, atopic keratoconjunctivitis and patients who refused HIV testing. Data collected included HIV status, CD4 count where appropriate, anti-nuclear antibodies and total serum immunoglobulin E. Results: 33 patients were included in this study; females n=16, males n=17. The mean age at presentation was 32.45±9.93 years, 95% CI=28.94-35.97. All of the patients were black Africans. One patient tested ANA positive. 51.5% of patients had a raised IgE level. A total of 13 of 25 HIV positive patients (52%) had a raised IgE. The proportion of HIV positive patients was statistically different from the HIV negative group, with Chi-squared = 21.866, p-value <0.0001. 72% of the HIV positive patients were grouped as immunodeficient according to their CD4 counts. An association was proven between severely immunodeficient patients and the risk of having VKC (chi-squared=4.992, p-value=0.0255). Conclusion: In this cohort a statistically significant association was found between adult-onset vernal keratoconjunctivitis and an HIV positive status. This association calls for more research on the subject, but could imply that patients presenting with adult-onset VKC should be offered an HIV test. Key words: Vernal keratoconjunctivitis, New-onset VKC Adult-onset VKC Ocular manifestations of HIV Allergy Immunocompromised.