TY - JOUR
T1 - Risk of cataract among subjects with acquired immune deficiency syndrome free of ocular opportunistic infections
AU - Kempen, John H.
AU - Sugar, Elizabeth A.
AU - Varma, Rohit
AU - Dunn, James P.
AU - Heinemann, Murk Hein
AU - Jabs, Douglas A.
AU - Lyon, Alice T.
AU - Lewis, Richard A.
N1 - Funding Information:
Supported by cooperative agreements from the National Institutes of Health , Bethesda, Maryland, to the Icahn School of Medicine at Mount Sinai (no.: U10 EY 08052), The Johns Hopkins University Bloomberg School of Public Health (no.: U10 EY 08057), and the University of Wisconsin, Madison, School of Medicine (no.: U10 EY 08067); the National Center for Research Resources through General Clinical Research Center to Baylor College of Medicine (grant no.: 5M01 RR 00350 ), the Johns Hopkins University School of Medicine (grant no.: 5M01 RR 00052 ), Louisiana State University/Tulane/Charity Hospital (grant no.: 5M01 RR 05096 ), the University of California , Los Angeles (grant no.: 5M01 RR 00865 ), the University of North Carolina (grant no.: 5M01 RR00046 ), the University of Southern California (grant no.: 5M01 RR00043 ), and Weill Medical College of Cornell University (grant no.: 5M01 RR00047 ); by cooperative agreements from Louisiana State University/Tulane (no.: U01 AI 27674), the University of California, Los Angeles (no.: U01 AI 27660), the University of California, San Diego (no.: U01 AI 27670), the University of California, San Francisco (no.: U01 AI 27663), the University of North Carolina (no.: U01 AI25868), Washington University at St. Louis (no.: U01 AI25903), and the University of Pennsylvania (no.: U01 AI32783); the Paul and Evanina Mackall Foundation, New York, New York; Research to Prevent Blindness, Inc. , New York, New York (J.H.K., D.A.J., R.A.L.); and the National Eye Institute , National Institutes of Health (grant no.: EY004505 [D.A.J.]). The Los Angeles Latino Eye Study is supported by a cooperative agreement from the National Institutes of Health (Bethesda, Maryland) to the University of Southern California (no.: U10-EY-11753). Dr. Varma is a Research to Prevent Blindness Sybil B. Harrington Scholar.
Publisher Copyright:
© 2014 American Academy of Ophthalmology.
PY - 2014/12/1
Y1 - 2014/12/1
N2 - Purpose: To evaluate the risk of cataract in the setting of AIDS. Design: Prospective cohort study. Participants: Subjects with AIDS free of ocular opportunistic infections throughout catamnesis. Methods: From 1998 through 2008, subjects 13 years of age or older were enrolled. Demographic characteristics and clinical characteristics were documented at enrollment and semiannually. Main Outcome Measures: Cataract was defined as high-grade lens opacity observed by biomicroscopy judged to be the cause of a best-corrected visual acuity worse than 20/40. Eyes that underwent cataract surgery during follow-up were considered to have developed cataract before the first visit when pseudophakia or aphakia was observed. Results: Among 1606 participants (3212 eyes) at enrollment, 1.9% (95% confidence interval [CI]: 1.3%-2.7%) were observed to have cataract or prior cataract surgery. Among the 2812 eyes initially free of cataract and followed longitudinally (median follow-up, 4.6 years), the incidence of cataract was 0.37%/eye-year (95% CI: 0.26%-0.53%). In addition to age, significant cataract risk factors included prior cataract in the contralateral eye (adjusted hazard ratio [aHR], 21.6; 95% CI: 10.4-44.8), anterior segment inflammation (aHR, 4.40; 95% CI: 1.64-11.9), prior retinal detachment (aHR, 4.94; 95% CI: 2.21-11.0), and vitreous inflammation (aHR, 7.12; 95% CI: 2.02-25.0), each studied as a time-updated characteristic. Detectable human immunodeficiency virus RNA in peripheral blood was associated with lower risk of cataract at enrollment (adjusted odds ratio, 0.32; 95% CI: 0.12-0.80) but not of incident cataract (aHR, 1.58; 95% CI: 0.90-2.76). After adjustment for other factors, neither the then-current absolute CD4+ T-cell count nor antiretroviral therapy status showed consistent association with cataract risk, nor did an additive diagnosis of other comorbidities. Compared with the available population-based studies that used similar definitions of cataract, the age-specific prevalence of cataract in our cohort was higher than in 1 of 2 such studies, and the age-specific incidence of cataract surgery was higher. Conclusions: Our results suggest cataract may occur earlier among patients with AIDS free of ocular opportunistic infections than in the general population. Cataract risk was associated most strongly with age and with other ocular morbidity in this population. With improved survival, the burden of cataract likely will increase for persons with the human immunodeficiency virus or AIDS.
AB - Purpose: To evaluate the risk of cataract in the setting of AIDS. Design: Prospective cohort study. Participants: Subjects with AIDS free of ocular opportunistic infections throughout catamnesis. Methods: From 1998 through 2008, subjects 13 years of age or older were enrolled. Demographic characteristics and clinical characteristics were documented at enrollment and semiannually. Main Outcome Measures: Cataract was defined as high-grade lens opacity observed by biomicroscopy judged to be the cause of a best-corrected visual acuity worse than 20/40. Eyes that underwent cataract surgery during follow-up were considered to have developed cataract before the first visit when pseudophakia or aphakia was observed. Results: Among 1606 participants (3212 eyes) at enrollment, 1.9% (95% confidence interval [CI]: 1.3%-2.7%) were observed to have cataract or prior cataract surgery. Among the 2812 eyes initially free of cataract and followed longitudinally (median follow-up, 4.6 years), the incidence of cataract was 0.37%/eye-year (95% CI: 0.26%-0.53%). In addition to age, significant cataract risk factors included prior cataract in the contralateral eye (adjusted hazard ratio [aHR], 21.6; 95% CI: 10.4-44.8), anterior segment inflammation (aHR, 4.40; 95% CI: 1.64-11.9), prior retinal detachment (aHR, 4.94; 95% CI: 2.21-11.0), and vitreous inflammation (aHR, 7.12; 95% CI: 2.02-25.0), each studied as a time-updated characteristic. Detectable human immunodeficiency virus RNA in peripheral blood was associated with lower risk of cataract at enrollment (adjusted odds ratio, 0.32; 95% CI: 0.12-0.80) but not of incident cataract (aHR, 1.58; 95% CI: 0.90-2.76). After adjustment for other factors, neither the then-current absolute CD4+ T-cell count nor antiretroviral therapy status showed consistent association with cataract risk, nor did an additive diagnosis of other comorbidities. Compared with the available population-based studies that used similar definitions of cataract, the age-specific prevalence of cataract in our cohort was higher than in 1 of 2 such studies, and the age-specific incidence of cataract surgery was higher. Conclusions: Our results suggest cataract may occur earlier among patients with AIDS free of ocular opportunistic infections than in the general population. Cataract risk was associated most strongly with age and with other ocular morbidity in this population. With improved survival, the burden of cataract likely will increase for persons with the human immunodeficiency virus or AIDS.
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U2 - 10.1016/j.ophtha.2014.06.014
DO - 10.1016/j.ophtha.2014.06.014
M3 - Article
C2 - 25109932
AN - SCOPUS:84922237802
SN - 0161-6420
VL - 121
SP - 2317
EP - 2324
JO - Ophthalmology
JF - Ophthalmology
IS - 12
ER -