Objective analysis of retinal damage in HIV-positive patients in the HAART era using OCT

Abstract

PURPOSE-To assess retinal nerve fiber layer (RNFL) thickness in patients with human immunodeficiency virus (HIV) disease without cytomegalovirus retinitis (CMV). DESIGN-A case-control study.METHODS-The study included 113 eyes of 65 patients in one center. Thickness of RNFL along a 3.4-mm-diameter circle centered on the optic nerve head was evaluated using third-generation optical coherence tomography. Patients in group A (39 eyes of 22 patients) were human immunodeficiency virus-negative control subjects. Group B (36 eyes of 18 patients) was composed of HIV patients with no history of CMV retinitis and CD4 counts consistently above 100. Group C (38 eyes of 25 patients) comprised HIV patients with no history of CMV retinitis but a history of CD4 count less than 100 at some point lasting for at least 6 months. RESULTS-The average RNFL thicknesses in groups A, B, and C were 103.33 ± 8.50 μm, 103.30 ± 9.28 μm, and 90.10 ± 12.50 μm, respectively. Group C had significantly thinner overall RNFL than either of the groups A and B (Tukey-Kramer). This difference was most prominent in temporal, superior, and inferior retinal areas. No difference was in nasal retinal area, nor between groups A and B in any of the areas.

Objective Analysis of Retinal Function in HIV-positive Children Without Retinitis Using Optical Coherence Tomography

“…Similar to our results, observations between those two retinal areas that reached statistical significance, however, were described in works by Varma 19 and later reports by Schuman 13 and are also supported by histologic data. 20 It is interesting that, like Kozak and associates, 17 our results show that the nasal retinal area has the less significant thinning. Interestingly, the areas of RNFL thinning in our HIV-positive patients correspond with the distribution of cotton-wool spots in patients with AIDS as described by Mansour and associates.…”

Relationship Between Retinal Nerve Fiber Layer and Visual Field Function in Human Immunodeficiency Virus–infected Patients Without Retinitis

“…6 It is hypothesized that damage to the inner retina caused by retinovascular abnormalities, including retinal cotton wool spots, leads to permanent impairment of the ganglion cell layer and RNFL with consequent visual function deterioration. [1][2][3][4][5]7,8 A strong spatial correlation has been observed between peripapillary RNFL damage measured by OCT and VF sensitivity in glaucoma. [9][10][11][12] This relationship has also been observed in other optic neuropathies, including compressive 13,14 and ischemic optic neuropathies.…”

“…RETINA 32:152-159, 2012 P atients infected by the human immunodeficiency virus (HIV), even those without a history of infectious retinitis, experience an optic nerve axonal loss that has been documented through retinal nerve fiber layer (RNFL) evaluation using laser scanning ophthalmoscopy (Heidelberg Retina Tomograph, Heidelberg Engineering, Heidelberg, Germany), 1,2 scanning laser polarimetry (GDx, Carl Zeiss Meditec, Dublin, CA), 2,3 and optical coherence tomography (OCT). 4 Visual field (VF) function abnormalities have also been observed in these patients; in a large cohort study of HIV-infected patients without infectious retinitis, 39% of the eyes displayed abnormal results on standard automated perimetry, 5 and a pattern of early VF loss has been shown to involve the superior and inferior regions. 6 It is hypothesized that damage to the inner retina caused by retinovascular abnormalities, including retinal cotton wool spots, leads to permanent impairment of the ganglion cell layer and RNFL with consequent visual function deterioration.…”

Human immunodeficiency virus and its effects on the visual system

“…However, a more common cause of optic atrophy in patients without significant retinopathy is AIDS-associated primary optic neuropathy. Generally up to 50% of axons within the optic nerve can be lost before the discs appear atrophic 38 but even asymptomatic HIV patients have axonal loss out of proportion to their degree of demyelination. 72 HIV-related optic neuropathy may occur more commonly than HIV retinopathy, as one autopsy study found HIV in 80% of optic nerves but only 20% of retinas.…”