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Prognostic effect of HIV on visual acuity in ocular syphilis: a systematic review

Eye volume 37, pages 3271–3281 (2023)Cite this article

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Abstract

Background/Objectives

Ocular syphilis is a vision-threatening disease that can lead to permanent blindness if left untreated. The global re-emergence of syphilis warrants greater investigations into the visual prognosis of eyes affected by this potentially devastating disease. This systematic review investigates the impact of HIV on visual acuity (VA) outcomes in ocular syphilis.

Methods

A literature search of Medline, PubMed, Embase, Clinicaltrials.gov and Cochrane Reviews was conducted for studies published between 01 January 2011 and 19 March 2022, reporting non-aggregate initial and post-treatment VA data of eyes with ocular syphilis and corresponding HIV status in patients ≥ 18 years.

Results

A total of 95 studies, including 364 patients and 568 eyes, were evaluated. Among people living with HIV with a diagnosis of ocular syphilis, affected eyes were more likely to have optic nerve involvement and panuveitis. However, HIV status, CD4 cell count, and HIV viral load were not predictive of VA outcomes of treated ocular syphilis. Prognostic factors of final VA worse than 1.00 logMAR were female sex, the presence of macular edema, and VA ≥ 1.00 at presentation. The strongest predictor of a worse final VA was VA ≥ 1.00 at presentation.

Conclusions

This systematic review demonstrates that HIV status, CD4 cell count, and HIV viral load are not significant factors impacting VA outcomes of eyes with ocular syphilis. While visual prognosis is generally good, poor visual outcome is most strongly predicted by poor VA at presentation. This underscores the importance of early recognition and treatment prior to permanent vision loss.

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Fig. 1: PRISMA style flow diagram showing selection of eligible studies.
Fig. 2: Initial vs. final visual acuity (VA) in eyes with ocular syphilis.

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Data availability

The datasets analysed in this work are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank Brianna Howell-Spooner with the Saskatchewan Health Authority library for conducting a preliminary literature review on this topic of study and Erin Watson with the University of Saskatchewan Library for her guidance in developing our literature search strategy.

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Authors and Affiliations

  1. College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada

    Laura Z. Wu & Tatiana M. Orlowski

  2. Department of Ophthalmology & Visual Sciences, University of Alberta, Edmonton, AB, Canada

    Malshi Karunatilake

  3. Division of Infectious Diseases, University of Saskatchewan, Regina, SK, Canada

    Stephen Lee

  4. Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada

    Prosanta Mondal

  5. Division of Infectious Diseases, University of Saskatchewan, Saskatoon, SK, Canada

    Siddharth Kogilwaimath

  6. Department of Ophthalmology, Western University, London, ON, Canada

    Lulu L. C. D. Bursztyn

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LZW was responsible for study concept and design, study design registration with PROSPERO, article screening and full-text review, risk of bias assessment, acquisition and interpretation of data, statistical analysis, manuscript drafting, updating reference lists, and creating tables and figures. TMO was responsible for article screening and full-text review, risk of bias assessment, acquisition and interpretation of data, manuscript drafting, updating reference lists. MK was responsible for analysis and interpretation of data, manuscript drafting, technical/administrative support. SL was responsible for analysis and interpretation of data, manuscript revision, technical/administrative support, and study supervision. PM was responsible for statistical analysis, analysis and interpretation of data, technical/administrative support, and manuscript revision. SK was responsible for analysis and interpretation of data, technical/administrative support, manuscript revision, and study supervision. LB was responsible for analysis and interpretation of data, technical/administrative support, manuscript drafting and revision, and study supervision.

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Wu, L.Z., Orlowski, T.M., Karunatilake, M. et al. Prognostic effect of HIV on visual acuity in ocular syphilis: a systematic review. Eye 37, 3271–3281 (2023). https://doi.org/10.1038/s41433-023-02504-0

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