Clinical manifestation and visual outcome in ocular toxoplasmosis among HIV-positive patients at a tertiary hospital in Bali: A 3-year retrospective study

Background: Ocular Toxoplasmosis is one of the most common ocular complications among patients with Human Immunodeficiency Virus (HIV), which frequently presents a sight-threatening condition. Anti-toxoplasmic therapy in combination with Highly Active Antiretroviral Therapy (HAART) has notably enhanced the prognosis of ocular toxoplasmosis. This paper aims to describe the characteristics of ocular Toxoplasmosis patients treated at a tertiary hospital in Bali, Indonesia, and evaluate the visual outcomes of their treatment. Methods: The study was an observational retrospective from January 2021 to December 2023 in the ophthalmology department of a tertiary care hospital in Bali, Indonesia. All HIV-positive patients with ocular Toxoplasmosis registered at Prof. I.G.N.G. Ngoerah Hospital Voluntary Counselling and Testing (VCT) Clinic were included. HAART was administered alongside with anti-toxoplasmic therapy. Results: In total, 17 ocular Toxoplasmosis patients were included in this research, with 23 eyes with Toxoplasmosis pathologies. Subjects were mainly diagnosed with posterior uveitis as the main ocular manifestation (52.2%), with chorioretinitis as the main finding (30.4%). No significant differences were found between visual acuity and ocular manifestation at the presenting condition or 3 months during treatment (p=0.484 and p=0.439, respectively). Baseline visual acuity prior and visual acuity at 3 months during treatment correlated significantly (p=0.001). The amount of CD4+ count and visual acuity at 3 months during treatment was also correlated significantly (p=0.028). Conclusion: Posterior uveitis is the most common manifestation of ocular toxoplasmosis among individuals with HIV/AIDS. Anti-toxoplasmic such as trimethoprim and sulfamethoxazole alongside HAART have been shown to reduce ocular morbidity and improve the visual outcome in HIV-positive patients.