Jabs Douglas A, Van Natta Mark L, Pak Jeong Won, Danis Ronald P, Hunt Peter W
Department of Ophthalmology, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Am J Ophthalmol. 2017 Jul;179:151-158. doi: 10.1016/j.ajo.2017.05.004. Epub 2017 May 10.
To evaluate the incidence of intermediate-stage age-related macular degeneration (AMD) in patients with acquired immunodeficiency syndrome (AIDS).
Cohort study.
Patients enrolled in the Longitudinal Study of the Ocular Complications of AIDS (LSOCA) underwent 5- and 10-year follow-up retinal photographs. Intermediate-stage AMD (AREDS stage 3) was determined from these photographs by graders at a centralized Reading Center, using the Age-Related Eye Disease Study-2 grading system. The incidence of AMD in LSOCA was compared with that in the Multi-Ethnic Study of Atherosclerosis (MESA), a Human Immunodeficiency Virus (HIV)-uninfected cohort, which used a similar photographic methodology.
The incidence of AMD in LSOCA was 0.65/100 person-years (PY). In a multivariate analysis the only significant risk factor for AMD in LSOCA was smoking; the relative risk vs never-smokers was 3.4 for former smokers (95% confidence interval [CI] 1.3, 9.5; P = .02) and 3.3 for current smokers (95% CI 1.1, 9.7; P = .03). Compared with the MESA cohort, the race/ethnicity- and sex-adjusted risk of AMD in LSOCA was 1.75 (95% CI 1.16, 2.64; P = .008), despite the fact that the mean age of the MESA cohort was 17 years greater than the LSOCA cohort (61 ± 9 years vs 44 ± 8 years).
Patients with AIDS have a 1.75-fold increased race- and sex-adjusted incidence of intermediate-stage AMD compared with that found in an HIV-uninfected cohort. This increased incidence is consistent with the increased incidence of other age-related diseases in antiretroviral-treated, immune-restored, HIV-infected persons when compared with HIV-uninfected persons.
评估获得性免疫缺陷综合征（AIDS）患者中中期年龄相关性黄斑变性（AMD）的发病率。
队列研究。
参加艾滋病眼部并发症纵向研究（LSOCA）的患者接受了5年和10年的视网膜随访照片。由中央阅读中心的分级人员使用年龄相关性眼病研究-2分级系统，根据这些照片确定中期AMD（年龄相关性眼病研究分级3期）。将LSOCA中AMD的发病率与动脉粥样硬化多民族研究（MESA）（一个未感染人类免疫缺陷病毒（HIV）的队列）中的发病率进行比较，MESA采用了类似的照相方法。
LSOCA中AMD的发病率为0.65/100人年（PY）。在多变量分析中，LSOCA中AMD的唯一显著危险因素是吸烟；与从不吸烟者相比，既往吸烟者的相对风险为3.4（95%置信区间[CI]1.3，9.5；P = 0.02），当前吸烟者为3.3（95%CI 1.1，9.7；P = 0.03）。与MESA队列相比，尽管MESA队列的平均年龄比LSOCA队列大17岁（61±9岁对44±8岁），但LSOCA中经种族/民族和性别调整后的AMD风险为1.75（95%CI 1.16，2.64；P = 0.008）。
与未感染HIV的队列相比，AIDS患者经种族和性别调整后的中期AMD发病率增加了1.75倍。这种发病率的增加与接受抗逆转录病毒治疗、免疫恢复的HIV感染者中其他年龄相关疾病的发病率增加相一致，与未感染HIV的人相比。
