Prevalence and Significance of Acquired Immunodeficiency Syndrome-Related Retinal Microvasculopathy

Freeman, William R.; Chen, Amy; Henderly, Dale E.; Levine, Alexandra M.; Luttrull, Jeffrey K.; Urrea, Paul T.; Arthur, James D.; Rasheed, Suraiya; Cohen, Jordan L.; Neuberg, Donna; Leung, Richard

doi:10.1016/0002-9394(89)90304-8

Cited by 97 publications

(27 citation statements)

References 25 publications

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“…In cases where lesions were questionable, the lesions were followed for progression (5,17). Progressive retinal opacification ruled out retinal cotton wool spots, the most common retinal lesion in AIDS patients (18). Other causes of retinitis were ruled out on the basis of the typical appearance of CMV retinitis.…”

Section: Methodsmentioning

confidence: 99%

Immune predispositions for cytomegalovirus retinitis in AIDS. The HNRC Group.

Schrier

Freeman²,

Wiley³

et al. 1995

J. Clin. Invest.

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CMV retinitis develops in -28-35% of all AIDS patients at later stages of disease, often leading to blindness. To determine whether the subset of AIDS patients who developed CMV retinitis (CMV-R) were immunologically predisposed, T cell proliferation responses to CMV were examined prospectively in an HIV infected, HLA typed, longitudinal study population. Individuals who developed CMV-R had significantly lower T cell proliferation responses to CMV, both early and late in disease, compared to CD4 matched controls who have not developed CMV-R.Since HLA proteins influence T-cell recognition, phenotypes of 21 CMV-R patients were examined to determine whether certain HLA alleles were associated with low immune response and predisposed AIDS patients to CMV-R. HLA DR7 and B44 were at increased (nearly twice the expected) frequency in those with CMV-R. The combined association of either B44, 51 or DR7 with CMV-R was highly significant (P = .008, relative risk of CMV-R = 15) with correction for multiple comparisons. Low immune responses were twice as frequent in those with (61%) compared to those without (30%) predisposing alleles. Thus, AIDS patients with immunogenetically related hyporesponsiveness to CMV antigens may be at increased risk of retinitis. (J. Clin. Invest. 1995. 95:1741-1746

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Section: Methodsmentioning

confidence: 99%

Immune predispositions for cytomegalovirus retinitis in AIDS. The HNRC Group.

Schrier

Freeman²,

Wiley³

et al. 1995

J. Clin. Invest.

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“…Cottonwool spots can be seen clinically in these patients and are more common as the immunodeficiency worsens. 5 Previous studies have shown that individuals infected with HIV without infectious retinitis show deficits in visual function. Several groups, including our own, have demonstrated reduced sensitivity in the field of vision using both standard and short-wavelength perimetry, 6,7 color and contrast sensitivity tests of central vision, [8][9][10][11] and electrophysiological testing, which has suggested that there is a retinal component to the vision loss.…”

mentioning

confidence: 99%

“…15 In HIV-positive patients without CMV retinitis, there is up to a 50% loss in nerve fiber population, notwithstanding the fact that the optic nerve clinically may appear normal. 16 We have hypothesized that such loss of myelinated optic nerve fibers is secondary to the inner retinal damage caused directly or indirectly by HIV.…”

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confidence: 99%

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

Kozák

Bartsch

Cheng

et al. 2005

American Journal of Ophthalmology

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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.

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“…Because CWS are strongly associated with a low CD4 count, controls were selected to have their CD4 count within 25% of the CD4 count of their CWS case. 18,32,33 All ophthalmologic data, neuropsychological data, and imaging data were initially collected on Macintosh personal computers using either Foxbase (Fox Software, Perysberg, OH, USA) or Fourth Dimension (ACI Incorporated, Cupertino, CA, USA) software. Subsequently, flat files were transferred to a SUN sparc workstation (Sun Microsystems, Mountainview, CA, USA) for analysis using S-plus (Statistical Sciences Inc., Seattle, WA, USA).…”

Section: Case-control Selectionmentioning

confidence: 99%

The relationship between AIDS retinal cotton wool spots and neuropsychological impairment in HIV-positive individuals in the pre-highly active antiretroviral therapy era

Freeman

McCutchan

Arévalo

et al. 2004

Ocular Immunology and Inflammation

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Purpose-To determine the relationship between AIDS retinal cotton wool spots (CWS) and neuropsychological impairment in HIV-positive individuals in the pre-HAART (highly active antiretroviral therapy) era and the association between AIDS-related retinal CWS and neuropsychological impairment in HIV-positive patients not treated with HAART.Methods-A case-control analysis of prospectively acquired data in HIV-infected individuals who underwent prospective and longitudinal evaluations of retinal findings as well as neuropsychological testing was performed. Individuals underwent prospective retinal ophthalmic examinations with fundus photography of any retinal lesions. They also underwent periodic neuropsychological testing. The occurrence of retinal CWS was analyzed in relationship to neuropsychological impairment.Results-Thirty individuals with CWS were compared to 60 matched control AIDS patients. There was no association between either global clinical neuropsychological impairment or impairment in any of the five major domains tested and retinal CWS. There was an association between beta-2 microglobulin and CWS as well as an association between low CD4 T-cell count and the presence of retinal CWS.Conclusions-We found no association between retinovascular disease and neurocognitive impairment in this case-control study. Retinal CWS in HIV disease are related to higher serum beta-2 microglobulin levels and lower CD4 T-cell counts, suggesting that these lesions are related to HIV disease progression but may be caused by a pathological process independent of CNS disease.

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Prevalence and Significance of Acquired Immunodeficiency Syndrome-Related Retinal Microvasculopathy

Cited by 97 publications

References 25 publications

Immune predispositions for cytomegalovirus retinitis in AIDS. The HNRC Group.

Immune predispositions for cytomegalovirus retinitis in AIDS. The HNRC Group.

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

The relationship between AIDS retinal cotton wool spots and neuropsychological impairment in HIV-positive individuals in the pre-highly active antiretroviral therapy era

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