Cai Jie, Xie Zi-Kang, Tang Dong-Yong, Zuo Hui-Yi, Liang Hao
Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Int J Ophthalmol. 2025 Mar 18;18(3):478-486. doi: 10.18240/ijo.2025.03.15. eCollection 2025.
To investigate the etiology of ocular pathogens and to establish the various pathogens present in human immunodeficiency virus (HIV) patients with cytomegalovirus retinitis (CMVR).
A total of 17 HIV-infected patients with concomitant eye disorders were enrolled. Patients were divided into CMVR group (10 patients, 18 eyes) and non-CMVR group (7 patients, 9 eyes) based on clinical manifestations and the presence of cytomegalovirus (CMV)-DNA in ocular specimens. The viral load of CMV was assessed using polymerase chain reaction in aqueous humor, vitreous fluid, and peripheral blood samples of patients in the CMVR group. Additionally, peripheral blood CD4 T cell counts were measured in both groups.
In the CMVR group, the CMV-DNA load in the vitreous and aqueous humor samples was substantially higher than in the peripheral blood samples (<0.01). CMV-DNA load in the aqueous humor and vitreous samples of the two eyes in the CMVR group was determined to be statistically significant (10 patients, 16 eyes, =0.018, 0.012). Peripheral blood CD4 T cell counts in the CMVR group were adversely linked with the CMV-DNA load in both the aqueous humor and peripheral blood (=0.005, 0.048). Compared with the non-CMVR group, the peripheral blood CD4 T cell count in the CMVR group decreased significantly (=0.014). The peripheral blood CD4 T cell count exceeded 300 cells/µL in 85.71% of non-CMVR patients, whereas it was below 100 cells/µL in 90.00% of the CMVR group. The intraocular specimens of the patients who underwent CMVR testing did not include any additional infections.
In HIV-associated CMVR patients, there may exist alternative, yet unidentified, infection pathways for intraocular CMV in addition to the conventional route. The substantial difference in CMV-DNA load between the eyes of most CMVR patients suggests that CMV may originate from different sources in each eye. The proportion of peripheral blood CD4 T cells in HIV patients is negatively correlated with the quantity of CMV viruses in their eyes. The peripheral blood count of <100 cells/µL indicates a considerable increase in the risk of concurrent CMVR. Multi-ocular pathogen presentations are uncommon in HIV individuals with CMVR.
调查眼部病原体的病因，并确定人类免疫缺陷病毒（HIV）合并巨细胞病毒性视网膜炎（CMVR）患者体内存在的各种病原体。
共纳入17例合并眼部疾病的HIV感染患者。根据临床表现及眼部标本中巨细胞病毒（CMV）-DNA的存在情况，将患者分为CMVR组（10例，18只眼）和非CMVR组（7例，9只眼）。采用聚合酶链反应检测CMVR组患者房水、玻璃体及外周血样本中的CMV病毒载量。此外，测量两组患者外周血CD4 T细胞计数。
CMVR组中，玻璃体和房水样本中的CMV-DNA载量显著高于外周血样本（<0.01）。CMVR组两眼房水和玻璃体样本中的CMV-DNA载量差异具有统计学意义（10例患者，16只眼，=0.018，0.012）。CMVR组外周血CD4 T细胞计数与房水和外周血中的CMV-DNA载量均呈负相关（=0.005，0.048）。与非CMVR组相比，CMVR组外周血CD4 T细胞计数显著降低（=0.014）。非CMVR组85.71%的患者外周血CD4 T细胞计数超过300个/µL，而CMVR组90.00%的患者外周血CD4 T细胞计数低于100个/µL。接受CMVR检测患者的眼内标本未发现其他感染。
在HIV相关CMVR患者中，除传统途径外，可能还存在其他尚未明确的眼内CMV感染途径。大多数CMVR患者两眼之间CMV-DNA载量的显著差异表明，CMV可能在每只眼中起源于不同来源。HIV患者外周血CD4 T细胞比例与眼内CMV病毒数量呈负相关。外周血计数<100个/µL表明并发CMVR的风险显著增加。在患有CMVR的HIV个体中，多眼病原体表现并不常见。
