Ophthalmic features of HIV associated cryptococcal meningitis in Malawian adults: An observational study [version 2; peer review: 1 approved, 1 approved with reservations]

Background: Cryptococcal meningitis (CM) is the commonest neurologiccomplication in patients with advanced HIV. Visual disturbance is a frequepresenting symptom. Papilloedema is commonly reported but other ophthalmic findings are not well described. Methods: We performed an observational study comparing severely immunocompromised HIV-infected patients with and without CM to determine the nature and prevalence of retinal pathology attributable to C70 adult patients were enrolled in Blantyre Malawi, 35 with CM and 35 HIV-infected patients without CM. Results: 79% (19/24) of CM patients examined on day one had evidence of retinal abnormalities compared to 17% (6/35) of HIV-infected controls (p <0.001). In the CM group, retinal whitening was the commonest abnormali(50%), followed by optic disc swelling (29%), haemorrhage (25%) and vascular abnormalities (7%). Retinal whitening was the only abnormality observed in the comparator group (17%). In CM, there was no significant difference between those with and without retinal abnormalities in fungal burden (13,550 cfu/ml vs. 9,150 cfu/ml; p = 0.65), CD4 count (28 cells/µl v76 cells/µl; p = 0.79) or CSF opening pressure (21cm H20 vs. 27cm H20; = 0.5). There was no association between presence/absence of retinal abnormalities and death (40% 10-week mortality vs. 26%; p = 0.6). Conclusions: Whether the presence of CM retinopathy could be used as marker of disease severity warrants further investigation. The observed ophthalmic findings provide a descriptive framework for CM retinopathy tbe utilised in future CM studies. Trial registration: ISRCTN (ISRCTN45035509) 19/06/2012.