TY - JOUR
T1 - Vision Function in HIV-Infected Individuals without Retinitis
T2 - Report of the Studies of Ocular Complications of AIDS Research Group
AU - Freeman, William R.
AU - Van Natta, Mark L.
AU - Jabs, Douglas
AU - Sample, Pamela A.
AU - Sadun, Alfredo A.
AU - Thorne, Jennifer
AU - Shah, Kayur H.
AU - Holland, Gary N.
N1 - Funding Information:
This study was supported by LSOCA grant support from the National Eye Institute, Bethesda, Maryland to The Johns Hopkins University School of Medicine, Baltimore, Maryland (U10 EY 08052), The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (U10 EY 08057), and the University of Wisconsin, Madison School of Medicine, Madison, Wisconsin (U10 EY 08067). Additional support provided by National Center for Research Resources through General Clinical Research Center Grants 5M01 RR 00350 (Baylor College of Medicine, Houston, Texas), 5M01 RR 05096 (Louisiana State University, Baton Rouge, Louisiana/Tulane /Charity Hospital, New Orleans, Louisiana), 5M01 RR00096 (New York University Medical Center, New York, New York), 5M01 RR 00865 (University of California, Los Angeles, California), 5M01 RR00046 (University of North Carolina, Chapell Hill, North Carolina), 5M01 RR00043 (University of Southern California, Los Angeles, California), 5M01 RR00047 (Weill Medical College of Cornell University, Ithaca, New York). Support also was provided through cooperative agreements U01 AI 27674 (Louisiana State University/Tulane), U01 AI 27660 (University of California, Los Angeles), U01 AI 27670 (University of California, San Diego, California), U01 AI 27663 (University of California, San Francisco, California), U01 AI25868 (University of North Carolina), U01 AI32783 (University of Pennsylvania, Philadelphia, Pennsylvania). Support also was provided by Research to Prevent Blindness, Inc, New York, New York; Dr Freeman is the recipient of a Research to Prevent Blindness Physician Scientist award. The authors indicate no financial conflict of interest. Involved in design of study (W.R.F., G.N.H.); conduct of study (W.R.F., M.L.V.N., D.J., P.A.S., A.A.S., J.T., K.H.S., G.N.H.); collection of data (W.R.F., M.L.V.N., D.J., P.A.S., A.A.S., J.T., K.H.S., G.N.H.); management of data (M.L.V.N.); analysis and interpretation of data (M.L.V.N., D.J., P.A.S., A.A.S., J.T., K.H.S.); preparation and review of the manuscript (W.R.F., M.L.V.N., D.J., P.A.S., A.A.S., J.T., K.H.S., G.N.H.); and approval of the manuscript (M.L.V.N., G.N.H., D.J., P.A.S., A.A.S., J.T., K.H.S.). The study and data accumulation were carried out with approval from the appropriate institutional review board, that informed consent was obtained from the patients, and that the study is in accordance with Health Insurance Portability and Accountability Act regulations.
PY - 2008/3
Y1 - 2008/3
N2 - Purpose: To evaluate the prevalence and risk factors for vision loss in patients with clinical or immunologic AIDS without infectious retinitis. Design: A prospective, multicenter cohort study of patients with AIDS. Methods: One thousand three hundred and fifty-one patients (2,671 eyes) at 19 clinical trials centers diagnosed with AIDS but without major ocular complications of HIV. Standardized measurements of visual acuity, automated perimetry, and contrast sensitivity were analyzed and correlated with measurements of patients' health and medical data relating to HIV infection. We evaluated correlations between vision function testing and HIV-related risk factors and medical testing. Results: There were significant (P < .05) associations between measures of decreasing vision function and indices of increasing disease severity, including Karnofsky score and hemoglobin. A significant relationship was seen between low-contrast sensitivity and decreasing levels of CD4+ T-cell count. Three percent of eyes had a visual acuity worse than 20/40 Snellen equivalents, which was significantly associated with a history of opportunistic infections and low Karnofsky score. When compared with external groups with normal vision, 39% of eyes had abnormal mean deviation on automated perimetry, 33% had abnormal pattern standard deviation, and 12% of eyes had low contrast sensitivity. Conclusions: This study confirms that visual dysfunction is common in patients with AIDS but without retinitis. The most prevalent visual dysfunction is loss of visual field; nearly 40% of patients have some abnormal visual field. There is an association between general disease severity and less access to care and vision loss. The pathophysiology of this vision loss is unknown but is consistent with retinovascular disease or optic nerve disease.
AB - Purpose: To evaluate the prevalence and risk factors for vision loss in patients with clinical or immunologic AIDS without infectious retinitis. Design: A prospective, multicenter cohort study of patients with AIDS. Methods: One thousand three hundred and fifty-one patients (2,671 eyes) at 19 clinical trials centers diagnosed with AIDS but without major ocular complications of HIV. Standardized measurements of visual acuity, automated perimetry, and contrast sensitivity were analyzed and correlated with measurements of patients' health and medical data relating to HIV infection. We evaluated correlations between vision function testing and HIV-related risk factors and medical testing. Results: There were significant (P < .05) associations between measures of decreasing vision function and indices of increasing disease severity, including Karnofsky score and hemoglobin. A significant relationship was seen between low-contrast sensitivity and decreasing levels of CD4+ T-cell count. Three percent of eyes had a visual acuity worse than 20/40 Snellen equivalents, which was significantly associated with a history of opportunistic infections and low Karnofsky score. When compared with external groups with normal vision, 39% of eyes had abnormal mean deviation on automated perimetry, 33% had abnormal pattern standard deviation, and 12% of eyes had low contrast sensitivity. Conclusions: This study confirms that visual dysfunction is common in patients with AIDS but without retinitis. The most prevalent visual dysfunction is loss of visual field; nearly 40% of patients have some abnormal visual field. There is an association between general disease severity and less access to care and vision loss. The pathophysiology of this vision loss is unknown but is consistent with retinovascular disease or optic nerve disease.
UR - http://www.scopus.com/inward/record.url?scp=39149109256&partnerID=8YFLogxK
U2 - 10.1016/j.ajo.2007.10.013
DO - 10.1016/j.ajo.2007.10.013
M3 - Article
C2 - 18191094
AN - SCOPUS:39149109256
SN - 0002-9394
VL - 145
SP - 453-462.e1
JO - American Journal of Ophthalmology
JF - American Journal of Ophthalmology
IS - 3
ER -