Profil des Lésions Ophtalmologiques au Cours de l’Infection à VIH/SIDA à Libreville

Tatiana Mba Aki, PA Assoumou, E Anyunzoghe, I Mistoul, M Vouma, S Mekyna, E Mve Mengome

Abstract



RÉSUMÉ
Introduction. Au Gabon, l’absence de données sur la question des lésions ophtalmologiques au cours du VIH a motivé ce travail. Objectif. Recenser les lésions ophtalmologiques observées au cours de l’infection à VIH/SIDA à Libreville. Patients et méthodes. Il s’agissait d’une étude observationnelle à visée descriptive menée sur une période de neuf mois à Libreville. Elle concernait 772 personnes vivant avec le VIH (PVVIH), suivis au CHU de Libreville. Les paramètres étudiés étaient l’âge, le sexe, les lésions ophtalmologiques et le taux de CD4 (< 200/mm3 et ≥ 200/mm3) (p < 0,05). Résultats. Au total, 213 lésions ophtalmologiques ont été recensées, dont 66,2% au niveau du segment postérieur. Les drusen rétiniens représentaient 37,6% des lésions, les uvéites antérieures séquellaires, 13,2%, et les choriorétinites 14,1%, dont 7% étaient d’origine toxoplasmique et 2,8% due au cytomégalovirus (CMV). Le taux moyen de CD4 dans la population d’étude était de 435 ± 301,4/mm3 [1-1429], dont 31% avaient un taux < 200/mm3. Il existait une relation entre la survenue des choriorétinites tous types confondus et la sévérité de l’immunodépression (CD4 < 200/mm3) (p = 0,043). Les taux moyens de CD4 étaient de 279/mm3 pour les patients avec une choriorétinite toxoplasmique et de 55,5/mm3 pour ceux ayant une choriorétinite à CMV. Conclusion. La prévalence des atteintes ophtalmologiques est faible chez les PVVIH à Libreville. Un grand nombre de lésions ophtalmologiques traditionnellement décrites a été recensé. Toutefois, la fréquence élevée des drusen rétiniens nous interpelle.
ABSTRACT
Introduction. Lack of data in Gabon on ophthalmological lesions during HIV led us to carry out this work. The objective of our work was to identify the ophthalmological lesions observed during HIV in Libreville. Patients and methods. This was a cross-sectional and observational descriptive study conducted over a nine-month period in Libreville. It involved 772 people living with HIV (PLHIV) followed at Libreville University Hospital. Studied parameters were age, sex, ophthalmological lesions and CD4 count (< 200/mm3 and ≥ 200/mm3) (p < 0.05). Results. A total of 213 ophthalmological disorders were identified, including 66.2% in the posterior segment. Retinal Drusen accounted for 37.6% of lesions, anterior uveitis 13.2%, and chorioretinitis 14.1%, of which 7% were of toxoplasmic origin and 2.8% due to cytomegalovirus (CMV). The average CD4 count in the study population was 435± 301.4/mm3 [1-1429], of which 31% had a rate < 200/mm3. There was a relationship between the occurrence of chorioretinitis of all types and the severity of immunosuppression (CD4 < 200/mm3) (p= 0.043). Mean CD4 levels were 279/mm3 for patients with toxoplasmic chorioretinitis and 55.5/mm3 for those with CMV chorioretinitis. Conclusion. This study found a low prevalence of ophthalmological damage among PLHIV in Libreville. A large number of traditionally described ophthalmological lesions have been identified. However, the high frequency of the retinian drusen is a challenge for us.


Keywords


VIH/SIDA – Drusen – Choriorétinite – Libreville

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