The Relationship between Neutrophil-Lymphocyte Ratio and Ocular Manifestations in Children with Human Immunodeficiency Virus

Children with Human Immunodeficiency Virus (HIV) face elevated risks of systemic and ocular complications, potentially leading to blindness, particularly in developing countries where cases are rising.  Aim To investigate the association between neutrophil-lymphocyte ratio (NLR) and ocular manifestations in children with Human Immunodeficiency Virus (HIV) infection.  Methods This cross-sectional study involved 75 HIV-positive children aged 5–18 years at Yayasan Peduli Anak, Medan, Indonesia, from October to December 2023. Data were collected via interviews, comprehensive eye examinations (visual acuity, slit-lamp biomicroscopy, Schirmer test, indirect ophthalmoscopy), and recent NLR from medical records. Systemic cytomegalovirus (CMV) infection was assessed via CMV PCR. Sample size was calculated for correlation analysis (α=0.05, power=0.80, effect size=0.5).  Results Of 75 participants (56% male, median age 11.64 years), 88% had normal immune status. Mean antiretroviral therapy (ARV) duration was 9.56 years. Common ocular complaints included blurry vision (24%), red/itchy eyes (16%), and watery eyes (4%); no dry eye was reported. Anterior segment findings included conjunctivitis (6%), blepharitis (8%), and corneal scarring (4%); posterior segment findings included tigroid fundus/nasalization (4%) and retinal detachment (2%). Mean NLR was 1.76 in those with ocular manifestations (p=0.024). CMV PCR positivity was significantly associated with blurry vision (OR=6.63; p=0.015), red eyes (OR=4.75; p=0.049), corneal scarring (OR=16.00; p=0.044), and nasalization (OR=16.00; p=0.044).  Conclusion Elevated NLR was associated with ocular manifestations in pediatric HIV, particularly CMV-related complications. Regular eye screenings and ARV adherence are critical for early detection and prevention of vision-threatening conditions.  Keywords: antiretroviral therapy, Cytomegalovirus, eye diseases, inflammation, pediatrics&nbsp.