Ocular manifestations of perinatal HIV infection in Kenyan children on HAART: a cross-sectional comparative study

Introduction: Human Immunodeficiency Virus (HIV) remains a global health concern, particularly in Africa. Highly Active Antiretroviral Therapy (HAART) has transformed HIV into a manageable chronic condition, but potential side effects, including ocular manifestations, are recognized. While ophthalmic complications in the pre-HAART era are well-documented, the current landscape in perinatally acquired HIV requires further investigation. This study aims to report the prevalence of ocular involvement in a cohort of children with perinatally acquired HIV. Methods: This cross-sectional study recruited 73 HIV-positive and 59 HIV-negative age-matched children in Kenya. All HIV+ children were on HAART. Comprehensive ophthalmological examinations included visual acuity, stereopsis, ocular motility assessment, tear film tests (BUT, Schirmer, Oxford staining), corneal esthesiometry, and an ocular allergy questionnaire. Clinical data on HIV parameters and HAART regimens were collected for the HIV+ group. Results: Visual acuity was comparable between groups. Both groups’ ocular surface parameters (BUT, Schirmer, Oxford score) were within normal limits. Ocular allergy prevalence was similar, but HIV+ children reported fewer symptoms (p=0.030). Strabismus was significantly more frequent in the HIV+ group (24.7% vs 8.5%, p=0.015), particularly in patients in treatment with abacavir (p=0.026). No significant correlation was found between HIV-related parameters and ocular surface findings. Conclusion: This study suggests that in the HAART era, perinatally HIV-infected children with well-managed viral loads show visual function and largely normal ocular surface health, contrasting with pre-HAART literature. The increased frequency of strabismus in HIV+ children and its potential association with abacavir warrant further investigation into HAART-related ocular motility side effects.