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Reduce risks of transmission when HIV/AIDS patients present


Currently, many individuals are living with acquired immune deficiency syndrome (AIDS), and optometrists are likely to have individuals infected with HIV/AIDS present as patients.

Key Points

AIDS has been reported since 1981, although it was probably active well before that. In the past 3 decades, AIDS has led to the deaths of more than 25 million people worldwide.

"What that means to us is that it's much more likely that we will encounter someone who has AIDS or who is HIV-infected," noted Dr. Semes, who is professor of optometry, University of Alabama at Birmingham.

Optometrists may be able to play a part, albeit limited, in minimizing transmissions and helping health organizations, such as the Centers for Disease Control and Prevention, reach their goal of significantly reducing the rate of new HIV infections, Dr. Semes added.

Watch for ophthalmic involvement

Although ophthalmic manifestations of HIV infection are common and require treatment in more than one-half of infected patients, many of these complications are not specific to a person who has HIV or AIDS. These can include tumors of the periocular tissues, external infections, keratitis, keratoconjunctivitis sicca, iridocyclitis, and retinopathy. HIV-associated retinopathy and opportunistic infections of the retina and choroid are also possible, as are neuro-ophthalmic manifestations, such as visual field defects, papilledema, and diplopia.

Some patients may not share their infection status with their optometrists, but certain findings may be suggestive of infection. For instance, a case of herpes zoster infection in a younger patient rather than a senior citizen may warrant a few questions about medication use that could reveal a diagnosis of HIV/AIDS.

Conjunctival microvasculopathy is not a specific sign but is highly prevalent in HIV/ AIDS patients. Patients may also have dry eye, but given its widespread prevalence in the general population, this finding should only be of concern if it seems to be unrelated to other systemic disorders, said Dr. Semes.

He also suggested that doctors monitor HIV/ AIDS patients closely for the ocular manifestations of opportunistic infections that are unlikely to affect immunocompetent patients under similar circumstances.

Controlling risks

For assistance in managing patients with HIV/ AIDS, clinicians who aren't located near resources, such as an infectious disease clinic, can turn to their county health department, Dr. Semes suggested. These agencies can offer patients information and services, including testing and referral resources.

If an optometric practice chooses to perform in-office HIV screening, the OraQuick Rapid HIV Test (OraSure Technologies) has high sensitivity and specificity, and produces results in about 20 minutes, Dr. Semes said.

Physicians should take steps to reduce the risk of transmitting HIV as well as other infectious diseases in their offices. Infection control processes for medical devices include cleaning, disinfection, and sterilization.

Cleaning consists of removing organic and inorganic contaminants from certain instruments and contact surfaces, while high-level disinfection is applied to the many instruments used between patients. Sterilization is the highest level, intended to kill all micro-bial life, including spores, and should be used on instruments, such as scalpels, forceps, or other instruments that come in direct contact with the circulation.

Alternatives to heat sterilization include various chemical products, such as glutaraldehyde or hydrogen peroxide (7.5%). Such products should be used with caution, Dr. Semes emphasized, because exposure to glutaraldehyde may have adverse health effects.

There are no worldwide parameters for cleaning or sterilizing ophthalmic instruments, although some manufacturers provide instructions. Further information is available from the Centers for Disease Control and other sources (Healthcare Infection Control Practices Advisory Committee, http://www.cdc.gov/hicpac/).

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