Multiple oncogenic viruses identified in Ocular surface squamous neoplasia in HIV-1 patients

Background  

Ocular surface squamous neoplasia (OSSN) is a rare cancer that has increased in incidence with the HIV pandemic in Africa. The underlying cause of this cancer in HIV-infected patients from Botswana is not well defined.     

Disparity in Access to Cataract Surgical Services Leads to Higher Prevalence of Blindness in Women as Compared With Men: Results of a National Survey of Visual Impairment

Aim: The aim of the survey was to estimate the prevalence and determinants of visual impairment and blindness in Botswana 50 years and older and assess access to cataract surgical services. Method: a multistage cluster randomized sampling with probability proportional to size was used to select a cross-sectional nationally representative sample of 2,662 subjects. The distance visual acuity was measured and the lens examined for cataracts in each subject. Where pinholes did not improve vision to 6/18 or better, fundus examination was done after mydriasis. Blindness was defined as vision <3/60 and visual impairment as <6/18 to 3/60 in the better eye with available correction. Results: Two thousand one hundred twenty-seven eligible subjects were examined (79.9%). Age- and sex-adjusted prevalence of blindness and severe visual impairment was 3.69% (95% CI: 2.38%?5.00%) and 1.69% (95% CI: 1.04%?2.33%), respectively. Cataracts were the main cause of blindness (46.9%), and severe (58.9%) and moderate (40.2%) visual impairment. After adjusting for age and sex, the prevalence of bilateral cataract blindness and bilateral severe visual impairment in men is 1.0% (95% CI: 0.001%–2.1%) and 1.5% (95% CI: 1.3%–1.7%) compared with 1.6% (95% CI: 0.6%–2.7%) and 2.1% (95% CI: 1.8%–2.8%) in women. 76.9% of men, bilaterally blind from cataract, had cataract surgery in one or both eyes compared with 59.4% of women. Overall, 65.4% of people bilaterally blind from cataract had surgery in one or both eyes. For vision <6/60, the cataract surgical coverage (CSC) for persons is 73.0%, 55.2%, and 61.5% for men, women, and the sample population, respectively. The CSC for persons at vision <6/18 is 62.3%, 48.3%, and 53.2% for men, women, and the sample population, respectively. Conclusion: Inequity in access to cataract surgery between men and women in Botswana has contributed to the higher prevalence of cataract-related blindness in women.     

Ocular complications of HIV infection in sub-Sahara Africa

This article reviews the magnitude and spectrum of ocular complications of HIV infection in sub-Sahara Africa. A literature search was done using PubMed, Google, and UpToDate and by talking to ophthalmologists and HIV experts working in the region. Ocular complications of HIV infection, mostly retinal, are seen in 29% to 71% of patients. Cytomegalovirus retinitis affects 0% to 16.5% of HIV-infected patients and is treated successfully with intravitreal ganciclovir in South Africa and Botswana. Ocular surface squamous neoplasia is seen in 4% to 7.8% of persons with HIV (a 5%–6% increase in Uganda and Tanzania), and recurrence after surgery occurs in 3.2% to 31.2%. In Zimbabwe, 45% of meningitis in adults is cryptococcal, and cryptococcal meningitis is the third leading cause of death in HIV patients in rural Uganda. In Rwanda, 9% of patients with cryptococcal meningitis developed visual loss and sixth nerve palsy. Thus, HIV infection leads to significant ocular morbidity in sub-Sahara Africa.