Transcript cicu ppt - University of Nairobi

A CASE-CONTROL STUDY ON PREVALENCE OF
KERATOCONJUNCTIVITIS SICCA
IN PATIENTS WITH HIV/AIDS ATTENDING THE
COUPLES COUNSELLING CENTRE IN KENYATTA
NATIONAL HOSPITAL
Presenter: Dr. Antonella Wanjiku
Supervisors: 1st Dr. Nyamori J. M
2nd Dr. Njuguna M. W.
INTRODUCTION
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Dry Eye syndrome is described as multifactorial
disease of tears and ocular surface leading to
symptoms of discomfort, visual disturbance and
tear film instability with potential damage to the
ocular surface
Definition and Classification Subcommittee of Dry Eye Workshop. Definition
and classification of Dry Eye Disease. 2007.
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INTRODUCTION CONTINUED…
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Dry eye syndrome affects performance of
everyday tasks such as reading, working on the
computer and watching television.
Impact of dry eye on reading in a population based sample of the elderly: the Salisbury
Eye Evaluation. van Landingham SW, West SK, Akpek EK, Muñoz B, Ramulu PY.
s.l. : Br J Opthal, 2013.
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LITERATURE REVIEW
The Beaver Dam Eye study of 2000 found a DES
prevalence of 17% in females and 11.1% in males.
 In Spain, studies done found a DES prevalence of
11% as opposed to 21% found in a study done in
the Beijing Eye Study, China.
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Prevalence of and Risk Factors for Dry Eye Syndrome. Scot E. Moss, MA,
Ronald Klein, MD and Barbara E. K. Klein, MD. 2000, JAMA
Ophthalmology.
Prevalence of and Associated Factors for Dry Eye in a Spanish Adult
Population (The Salnes Eye Study). ELoy Viso, Maria Theresa
Rodriguez-Ares et al. s.l. : Informa Healthcare, 2009.
Prevalence of dry eye among adult Chinese in the Beijing Eye Study. Y Jie, L
Xu, Y Y Wu. s.l. : Nature Publishing Group, 2008.
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Lucca et al showed a prevalence of 17% in HIV
positive female patients compared with 21% of
male HIV positive patients in USA.
 DES in HIV accounts for 20-38.8% in India
compared with 53% in a study done in Tanzania.
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Keratoconjunctivitis Sicca in Female Patients Infected with Human
Immunodeficiency Virus. Lucca, John A. MD, Kung, John S. MD and
Farris, R Linsy MD. s.l. : Contact Lens Association of Ophthalmologist
Journal, 1994.
Keratoconjunctivitis sicca in male patients infected with human
immunodeficiency virus type 1. Lucca, John A. MD, Kung, John S. MD
and Farris, R Linsy MD. s.l. : Europe Pubmed Cental, 1994.
Anterior segment manifestations of human immunodeficiency virus/acquired
immune deficiency syndrome. Jyotirmay Biswas, S. Sudharshan. s.l. :
Indian Journal of Ophthalmology, 2008.
HIV- and AIDS-related Ocular Manifestations in Tanzanian Patients.
Sahoo, Soumendra. s.l. : Malysian Journal of Medical Sciences, 2010.
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JUSTIFICATION
With better life expectancy of people living with
HIV/AIDS more HIV-related eye conditions are
being encountered.
 No study has been done on DES in HIV in Kenya
 Findings from this study could be included by
primary care physicians in their comprehensive
care of patients living with HIV/AIDS to identify,
treat or refer cases of DES
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OBJECTIVES
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Main Objective
 To investigate an association between human
immunodeficiency virus (HIV) infection and
dry eye syndrome.
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OBJECTIVES CTD…
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Specific Objectives
 To investigate the relationship between CD4
cell count and presence/severity of DES
 To investigate the relationship between use of
HAART and DES in these patients
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METHODOLOGY
Study design: Case-control study
 Study population: Discordant couples
attending the CCC at KNH.
 Inclusion criteria: consenting adults, HIV
positive with up to date CD4 cell count (< 6
months prior) and their partners (whether
positive or negative)
 Exclusion criteria: No recent CD4 cell count
{>6 months}, confounding factors and
comorbidities {Diabetes, corneal scars, contact
wearers, SJS, arthritis, patients already on
treatment for DES, oral contraceptive pills, other
eye drops within last 1 month}
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Sample size determination (Lwanga SK &
Lameshow S, 1991)
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N = sample size
 Z = confidence interval
 P = unknown population prevalence (50%)
 D = margin of error (+ 10%)
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METHODOLOGY CTD…
 Sampling
method:
 All couples attending the KNH CCC who give
consent to join the study will fill in the
questionnaire.
 The first level of filtering will be done from
the questionnaire.
 Second level of filtering by examination.
.
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Patients who do not have confounders will then
have VA taken. VA less than 6/9 will be referred
for further examination in the eye clinic.
 They will then be examined on the slit lamp for
crusts, tear margin meniscus, frothy discharge
and conjunctival injection.
 After this, Schirmer’s test will be done followed
by tear break up time three times and the
average taken.
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Data collection Instruments:
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Questionnaire
Snellen’s Chart
Slit lamp
Fluorescein strips
Schirmer’s Test strips
Tetracaine Eye drops
Stop watch
Laptop
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METHODOLOGY CTD…
 Those
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who fit criteria:
VA using Snellen chart. Patients with vision
below 6/9 will be referred for further
examination.
Slit lamp examination will assess eye lashes for
crusts, tear margin meniscus, frothy discharge
and conjunctival injection
Schirmer’s test
TBUT (average of 3 readings)
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DATA MANAGEMENT
Questionnares will be scanned into Limesurvey
via queXF.
 Data will be stored on the laptop, on a separate
flash disk and online under lock and key with
password protection.
 Data will be analysed using SPSS.
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ETHICAL CONSIDERATIONS
Ethical approval will be sought from the
Kenyatta National Hospital/University of Nairobi
Ethics and Research Committee.
 Informed consent will be obtained from all those
participating in the study.
 All information volunteered will be held in
confidence and confidentiality maintained
throughout the study.
 Patients found with DES will be commenced on
treatment while those needing further work up
will be referred accordingly.
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QUESTIONNAIRE
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