A CASE-CONTROL STUDY ON PREVALENCE OF KERATOCONJUNCTIVITIS SICCA IN PATIENTS WITH HIV/AIDS ATTENDING THE COUPLES COUNSELLING CENTRE IN KENYATTA NATIONAL HOSPITAL

Presenter: Dr. Antonella Wanjiku

Supervisors: 1st Dr. Nyamori J. M

2nd Dr. Njuguna M. W.

INTRODUCTION

Dry Eye syndrome is described as multifactorial disease of tears and ocular surface leading to symptoms of discomfort, visual disturbance and tear film instability with potential damage to the ocular surface

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Definition and Classification Subcommittee of Dry Eye Workshop. Definition and classification of Dry Eye Disease. 2007.

INTRODUCTION CONTINUED…

Dry eye syndrome affects performance of everyday tasks such as reading, working on the computer and watching television.

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Impact of dry eye on reading in a population based sample of the elderly: the Salisbury Eye Evaluation. van Landingham SW, West SK, Akpek EK, Muñoz B, Ramulu PY. s.l. : Br J Opthal, 2013.

LITERATURE REVIEW The Beaver Dam Eye study of 2000 found a

DES prevalence of 17% in females and 11.1% in males.

In Spain, studies done found a DES prevalence of 11% as opposed to 21% found in a study done in the Beijing Eye Study, China.

Prevalence of and Risk Factors for Dry Eye Syndrome. Scot E. Moss, MA, Ronald Klein, MD and Barbara E. K. Klein, MD. 2000, JAMA Ophthalmology.

Prevalence of and Associated Factors for Dry Eye in a Spanish Adult Population (The Salnes Eye Study). ELoy Viso, Maria Theresa Rodriguez-Ares et al. s.l. : Informa Healthcare, 2009.

Prevalence of dry eye among adult Chinese in the Beijing Eye Study. Y Jie, L Xu, Y Y Wu. s.l. : Nature Publishing Group, 2008.

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Lucca et al showed a prevalence of 17% in HIV positive female patients compared with 21% of male HIV positive patients in USA.

DES in HIV accounts for 20-38.8% in India compared with 53% in a study done in Tanzania.

Keratoconjunctivitis Sicca in Female Patients Infected with Human Immunodeficiency Virus. Lucca, John A. MD, Kung, John S. MD and Farris, R Linsy MD. s.l. : Contact Lens Association of Ophthalmologist Journal, 1994.

Keratoconjunctivitis sicca in male patients infected with human immunodeficiency virus type 1. Lucca, John A. MD, Kung, John S. MD and Farris, R Linsy MD. s.l. : Europe Pubmed Cental, 1994.

Anterior segment manifestations of human immunodeficiency virus/acquired immune deficiency syndrome. Jyotirmay Biswas, S. Sudharshan. s.l. : Indian Journal of Ophthalmology, 2008.

HIV- and AIDS-related Ocular Manifestations in Tanzanian Patients. Sahoo, Soumendra. s.l. : Malysian Journal of Medical Sciences, 2010.

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JUSTIFICATION

With better life expectancy of people living with HIV/AIDS more HIV-related eye conditions are being encountered.

No study has been done on DES in HIV in Kenya

Findings from this study could be included by primary care physicians in their comprehensive care of patients living with HIV/AIDS to identify, treat or refer cases of DES

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OBJECTIVES

Main ObjectiveTo investigate an association between

human immunodeficiency virus (HIV) infection and dry eye syndrome.

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OBJECTIVES CTD…

Specific Objectives To investigate the relationship between

CD4 cell count and presence/severity of DES

To investigate the relationship between use of HAART and DES in these patients

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METHODOLOGY Study design: Case-control study Study population: Discordant couples

attending the CCC at KNH. Inclusion criteria: consenting adults, HIV

positive with up to date CD4 cell count (< 6 months prior) and their partners (whether positive or negative)

Exclusion criteria: No recent CD4 cell count {>6 months}, confounding factors and comorbidities {Diabetes, corneal scars, contact wearers, SJS, arthritis, patients already on treatment for DES, oral contraceptive pills, other eye drops within last 1 month}

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Sample size determination (Lwanga SK & Lameshow S, 1991)

N = sample size Z = confidence interval P = unknown population prevalence (50%) D = margin of error (+ 10%)

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METHODOLOGY CTD…

Sampling method: All couples attending the KNH CCC who

give consent to join the study will fill in the questionnaire.

The first level of filtering will be done from the questionnaire.

Second level of filtering by examination..

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Patients who do not have confounders will then have VA taken. VA less than 6/9 will be referred for further examination in the eye clinic.

They will then be examined on the slit lamp for crusts, tear margin meniscus, frothy discharge and conjunctival injection.

After this, Schirmer’s test will be done followed by tear break up time three times and the average taken.

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Data collection Instruments: Questionnaire Snellen’s Chart Slit lamp Fluorescein strips Schirmer’s Test strips Tetracaine Eye drops Stop watch Laptop

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METHODOLOGY CTD…

Those who fit criteria:VA using Snellen chart. Patients with vision

below 6/9 will be referred for further examination.

Slit lamp examination will assess eye lashes for crusts, tear margin meniscus, frothy discharge and conjunctival injection

Schirmer’s testTBUT (average of 3 readings)

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DATA MANAGEMENT

Questionnares will be scanned into Limesurvey via queXF.

Data will be stored on the laptop, on a separate flash disk and online under lock and key with password protection.

Data will be analysed using SPSS.

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ETHICAL CONSIDERATIONS

Ethical approval will be sought from the Kenyatta National Hospital/University of Nairobi Ethics and Research Committee.

Informed consent will be obtained from all those participating in the study.

All information volunteered will be held in confidence and confidentiality maintained throughout the study.

Patients found with DES will be commenced on treatment while those needing further work up will be referred accordingly.

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QUESTIONNAIRE

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