Thorne Jennifer E, Jabs Douglas A, Kempen John H, Holbrook Janet T, Nichols Charles, Meinert Curtis L
Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Ophthalmology. 2006 Aug;113(8):1432-40. doi: 10.1016/j.ophtha.2006.03.021. Epub 2006 Jun 12.
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).
Multicenter prospective observational study.
Three hundred seventy-nine patients with AIDS and CMV retinitis (494 eyes).
Follow-up every 3 months with medical history, ophthalmologic examination, and laboratory testing.
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.
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).
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.
描述在高效抗逆转录病毒治疗（HAART）时代，艾滋病合并巨细胞病毒（CMV）视网膜炎患者视力丧失的发生率及危险因素。
多中心前瞻性观察研究。
379例艾滋病合并CMV视网膜炎患者（494只眼）。
每3个月进行随访，包括病史采集、眼科检查和实验室检测。
CMV视网膜炎受累眼视力丧失至20/50或更差、至20/200或更差以及视角加倍的发生率。
在494只患有CMV视网膜炎的眼中，视力丧失至20/50或更差以及至20/200或更差的基线频率分别为29%和15%。在中位随访期3.1年期间，视力丧失至20/50或更差、至20/200或更差以及视角加倍的发生率分别为0.10/眼年（EY）、0.06/EY和0.13/EY。在调整混杂因素后，免疫恢复与视力丧失至20/50或更差的风险降低42%以及视力丧失至20/200或更差的风险降低61%相关。基线时免疫恢复的患者中，17%患有免疫恢复性葡萄膜炎（IRU）。在这些患者中，视力降至20/50或更差的发生率与未免疫恢复患者相似（0.17/EY对0.16/EY），但视力降至20/200或更差的发生率与免疫恢复患者相似（0.04/EY对0.04/EY）。
在HAART时代，CMV视网膜炎与视力丧失的显著风险相关。那些因HAART导致免疫恢复的患者视力丧失风险降低约50%。基线时存在IRU减弱了免疫恢复对中度视力丧失的保护作用，但对失明无此作用。
