Orbital Infections in Patients with Human Immunodeficiency Virus Infection

Abstract

Background: Orbital infections in individuals with Human Immunodeficiency Virus (HIV) are more aggressive, often involve opportunistic pathogens, and pose a significant risk of vision loss and systemic complications. Advanced immunosuppression, particularly low CD4 counts, increases the risk and severity of these infections.

Aim: To evaluate the clinical profile, microbial etiology, and treatment outcomes of orbital infections in HIV-positive patients.

Methods: This hospital-based prospective observational study was conducted over one year at a tertiary care center in Himachal Pradesh, India. Thirty-two HIV-positive patients with clinical and/or radiological evidence of orbital infection were included. Clinical presentation, CD4 counts, microbiological findings, imaging results, treatment modalities, and outcomes were recorded and analyzed using SPSS version 23.0. Associations between infection type and CD4 count were assessed using Chi-square and Fisher’s exact tests.

Results: The mean age was 38.7 years, with a male predominance (62.5%). Most patients (78.1%) had CD4 counts <200 cells/mm³. Common presenting symptoms included proptosis (87.5%), periorbital swelling (81.3%), and pain (75%). Bacterial infections were most common (50%), followed by fungal (31.3%), viral (12.5%), and tubercular (6.3%) causes. Fungal and viral infections were significantly associated with CD4 counts <200 (p=0.003 and p=0.015, respectively). Surgical intervention was required in 31.3% of patients. Permanent vision loss occurred in 15.6%, and one death (3.1%) due to mucormycosis was reported.

Conclusion: Orbital infections in HIV-positive patients are associated with significant immunosuppression and varied microbial etiologies. Opportunistic fungal and viral infections are more common in patients with low CD4 counts and contribute to adverse outcomes.

Recommendations: Routine ophthalmologic screening of HIV-positive individuals, especially those with CD4 <200 cells/mm³, is essential. Early imaging and microbiological evaluation should be integrated into standard protocols. Enhancing adherence to antiretroviral therapy and timely intervention can reduce complications.

Keywords: HIV, Orbital infections, CD4 count, Opportunistic pathogens, Vision loss