Human immunodeficiency virus and CD4 count in ocular surface squamous neoplasia.

Abstract

During my time working at various eye clinics in Kwazulu-Natal, I observed that more often than not, patients with disfiguring ocular surface squamous neoplasia (OSSN) were Human Immunodeficiency virus (HIV) positive and generally quite ill, often requiring radical ophthalmic surgery for the tumour and urgent referral to the local Centre for Disease control (CDC) and HIV/Acquired Immunodeficiency Syndrome (AIDS) clinics, whereas the patients with conjunctival intraepithelial neoplasia (CIN) were usually HIV negative or HIV positive but well looking. This sparked the question of whether or not there may be a relationship between Cluster of Differentiation 4: a glycoprotein found on the surface of immune cells (CD4) counts and OSSN in HIV positive patients and could these findings – should they be in the affirmative – be used as a CDC case defining criteria for AIDS and streamlet referral of these patients for Highly Active Antiretroviral Therapy (HAART). Although HIV/AIDS is a global pandemic and has been linked to OSSN, an extensive literature search found no studies specifically looking at CD4 counts in these patients. My study titled “Human Immunodeficiency Virus and CD4 count in ocular surface squamous neoplasia” was thus born. I elected to perform my study in two parts. Firstly a prospective descriptive study to determine the prevalence of HIV in OSSN in my study population from September 2012 to December 2014, and secondly a case control study to determine the odds ratio of CD4 counts in HIV positive patients with OSSN (cases) and those without OSSN (controls) I hypothesized that: 1. >50% of patients with OSSN have HIV and 2. At least 90% of HIV patients with OSSN have a CD4 count <350 cells/μl. It was unfortunate that the number of cases recruited in the given time fell short of the ideal number required as outlined in my protocol, however a minimum of 3 controls per case (as opposed to one) all matched for age and gender were selected from the national data base in order to improve the statistical significance and proceed with the study. I had hoped that the results from this study could be used to include OSSN as a CDC case defining condition for AIDS but unfortunately, although illustrative of the possibility, larger studies will have to be conducted to prove this. I was however, able to achieve the listed aims of the study and prove both of the hypotheses. It is hoped that in doing so, the holistic management of these patients with OSSN will be improved with their referral for HIV and AIDS screening being streamlined and emphasized.