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Douglas A Jabs, Mark L Van Natta, Efe Sezgin, Jeong Won Pak, Ronald P Danis, ; Prevalence of Intermediate-Stage Age-Related Macular Degeneration in Patients with the Acquired Immunodeficiency Syndrome. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1409.
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Antiretroviral-treated, immunorestored, HIV-infected persons have evidence of accelerated and accentuated aging manifested as an increased prevalence of age-related diseases at younger ages than non-HIV-infected persons. We evaluated the prevalence of age-related macular degeneration (AMD) in patients with the acquired immunodeficiency syndrome (AIDS).
The Longitudinal Study of the Ocular Complications of AIDS (LSOCA) is a prospective cohort study of patients with AIDS performed during the modern era of combination antiretroviral therapy. Retinal photographs were performed at enrollment. Photographs were graded at a Reading Center using the Age-Related Eye Disease Study 2 (AREDS2) grading system. The primary outcome was intermediate-stage AMD. Results were compared to those published for the Beaver Dam Eye Study (BDES), in which photographic grading was performed at the same institution as the LSOCA grading, using similar protocols.
Of 1825 participants with AIDS and no ocular opportunistic infections, 9.9% had intermdeiate-stage AMD. The prevalence of AMD ranged from 4.0% for participants 30-39 years of age to 24.3% for participants >60 years of age. Risk factors identified in the multivariate analysis included age and HIV-infection risk group. Odds ratios were 1.9 for every decade of age (95% CI 1.6, 2.3, P<0.001), 2.4 for injection drug use (95% CI 1.5, 3.9, P<0.001), and 1.9 for heterosexual transmission of HIV (95% CI 1.3, 2.8,P=0.001). Neither antiretroviral drug use at enrollment nor class of antiretroviral drug use was associated with AMD. Compared to the non-HIV-infected population in the BDES, there was a 4.1-fold increased age-adjusted prevalence of intermediate-stage AMD (95% CI 3.2, 5.3).
Patients with AIDS have an increased prevalence of intermediate-stage AMD compared with similarly-aged, non-HIV-infected persons. This increased prevalence of AMD may relate to the state of chronic immune activation and systemic inflammation present in HIV-infected persons and is consistent with the increase in other age-related diseases among them.
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