TY - JOUR
T1 - Incidence of and Risk Factors for Visual Acuity Loss among Patients with AIDS and Cytomegalovirus Retinitis in the Era of Highly Active Antiretroviral Therapy
AU - Thorne, Jennifer E.
AU - Jabs, Douglas A.
AU - Kempen, John H.
AU - Holbrook, Janet T.
AU - Nichols, Charles
AU - Meinert, Curtis L.
N1 - Funding Information:
Supported by the National Eye Institute, Bethesda, Maryland, to The Johns Hopkins University School of Medicine (cooperative agreement no.: U10 EY 08052), The Johns Hopkins University Bloomberg School of Hygiene and Public Health (cooperative agreement no.: U10 EY 08057), and University of Wisconsin, Madison, School of Medicine (cooperative agreement no.: U10 EY 08067). Additional support provided by the National Center for Research Resources, Bethesda, Maryland, through the General Clinical Research Center to Baylor College of Medicine (grant no.: 5M01 RR 00350), Louisiana State University/Tulane/Charity Hospital (grant no.: 5M01 RR 05096), University of California, Los Angeles (grant no.: 5M01 RR 00865), University of North Carolina (grant no.: 5M01 RR00046), University of Southern California (grant no.: 5M01 RR00043), and Weill Medical College of Cornell University (grant no.: 5M01 RR00047). Support also provided by the National Eye Institute through cooperative agreements with Louisiana State University/Tulane (cooperative agreement no.: U01 AI 27674), University of California, Los Angeles (cooperative agreement no.: U01 AI 27660), University of California, San Diego (cooperative agreement no.: U01 AI 27670), University of California, San Francisco (cooperative agreement no.: U01 AI 27663), University of North Carolina (cooperative agreement no.: U01 AI25868), Washington University at St. Louis (cooperative agreement no.: U01 AI25903), and University of Pennsylvania (cooperative agreement no.: U01 AI32783). Additional support provided by the National Eye Institute (grant nos.: EY13707 [JET], EY 00405 [DAJ]) and an unrestricted grant from Research to Prevent Blindness, New York, New York (JHK).
PY - 2006/8
Y1 - 2006/8
N2 - Purpose: To describe the incidence of and risk factors for visual acuity loss among patients with AIDS and cytomegalovirus (CMV) retinitis in the era of highly active antiretroviral therapy (HAART). Design: Multicenter prospective observational study. Participants: Three hundred seventy-nine patients with AIDS and CMV retinitis (494 eyes). Methods: Follow-up every 3 months with medical history, ophthalmologic examination, and laboratory testing. Main Outcome Measures: Incidence of visual acuity loss to 20/50 or worse, to 20/200 or worse, and of doubling of the visual angle in eyes affected with CMV retinitis. Results: Among the 494 eyes with CMV retinitis, the baseline frequencies of visual acuity loss to 20/50 or worse and to 20/200 or worse were 29% and 15%, respectively. Over a median follow-up period of 3.1 years, the incidences of visual acuity loss to 20/50 or worse, to 20/200 or worse, and of doubling of the visual angle were 0.10/eye-year (EY), 0.06/EY, and 0.13/EY, respectively. Immune recovery was associated with a 42% reduction in vision loss to 20/50 or worse and with a 61% reduction in vision loss to 20/200 or worse after adjusting for confounding. Of the patients with immune recovery at baseline, 17% had immune recovery uveitis (IRU). In these patients, the incidence rate of 20/50 or worse vision was similar to that observed in patients without immune recovery (0.17/EY vs. 0.16/EY), but the incidence of 20/200 or worse vision was similar to that observed among patients with immune recovery (0.04/EY vs. 0.04/EY). Conclusions: Cytomegalovirus retinitis is associated with a substantial risk of incident vision loss in the era of HAART. Those who have HAART-induced immune recovery have approximately 50% lower risk of visual acuity loss. Presence of IRU at baseline attenuated the protective effect of immune recovery for moderate vision loss but not for blindness.
AB - Purpose: To describe the incidence of and risk factors for visual acuity loss among patients with AIDS and cytomegalovirus (CMV) retinitis in the era of highly active antiretroviral therapy (HAART). Design: Multicenter prospective observational study. Participants: Three hundred seventy-nine patients with AIDS and CMV retinitis (494 eyes). Methods: Follow-up every 3 months with medical history, ophthalmologic examination, and laboratory testing. Main Outcome Measures: Incidence of visual acuity loss to 20/50 or worse, to 20/200 or worse, and of doubling of the visual angle in eyes affected with CMV retinitis. Results: Among the 494 eyes with CMV retinitis, the baseline frequencies of visual acuity loss to 20/50 or worse and to 20/200 or worse were 29% and 15%, respectively. Over a median follow-up period of 3.1 years, the incidences of visual acuity loss to 20/50 or worse, to 20/200 or worse, and of doubling of the visual angle were 0.10/eye-year (EY), 0.06/EY, and 0.13/EY, respectively. Immune recovery was associated with a 42% reduction in vision loss to 20/50 or worse and with a 61% reduction in vision loss to 20/200 or worse after adjusting for confounding. Of the patients with immune recovery at baseline, 17% had immune recovery uveitis (IRU). In these patients, the incidence rate of 20/50 or worse vision was similar to that observed in patients without immune recovery (0.17/EY vs. 0.16/EY), but the incidence of 20/200 or worse vision was similar to that observed among patients with immune recovery (0.04/EY vs. 0.04/EY). Conclusions: Cytomegalovirus retinitis is associated with a substantial risk of incident vision loss in the era of HAART. Those who have HAART-induced immune recovery have approximately 50% lower risk of visual acuity loss. Presence of IRU at baseline attenuated the protective effect of immune recovery for moderate vision loss but not for blindness.
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U2 - 10.1016/j.ophtha.2006.03.021
DO - 10.1016/j.ophtha.2006.03.021
M3 - Article
C2 - 16766032
AN - SCOPUS:33746281697
SN - 0161-6420
VL - 113
SP - 1432
EP - 1440
JO - Ophthalmology
JF - Ophthalmology
IS - 8
ER -