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Alice T. Lyon, Sapna Gangaputra, Jennifer E. Thorne, Vijay Vaidya, Lea T. Drye, Longitudinal Study of Ocular Complications of AIDS(LSOCA) Research Group; Non-Cytomegalovirus Related Ocular Opportunistic Infections in Patients With AIDS. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6220.
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To report the frequency, incidence and characteristics of non-cytomegalovirus (non-CMV) ocular opportunistic infections (OOI) in the LSOCA cohort.
LSOCA is a multicenter, prospective, observational study of patients with AIDS. Medical history, ophthalmologic examination including visual acuity (VA), contrast sensitivity (CS), Goldman and Humphrey visual field (GVF, HVF), fundus photography and laboratory tests were performed at enrollment and every 6 months subsequently. Participants were classified as prevalent OOI if diagnosed prior to enrollment, and incident OOI when diagnosed <45 days from enrollment or anytime during follow up.
At enrollment, non-CMV OOI was diagnosed in 11 patients (18 eyes) as herpetic retinitis (HR), 8 patients (9 eyes) as toxoplasmic retinitis (TR), and 6 patients (8 eyes) as choroiditis (CH). During the follow up period, incident HR developed in 6 patients (10 eyes), TR developed in 4 patients (4 eyes) and CH developed in 6 patients (10 eyes). The incidence rates were 0.05, 0.05, and 0.03 per 100 person-years (PY) for HR, TR, and CH, respectively. Eyes with longstanding OOI had low CD4 counts at enrollment (median 66, 107, and 205 cells/μL) and low nadir CD4 counts (median 10, 56, and 32 cells/µL). Eyes with longstanding HR had the poorest visual outcomes with VA 20/40 or worse in 89%, GVF 600 or worse in 83%, log CS 1.5 or less in 93% and HVF mean deviation of -2.63 or worse in 100%. Less than 5% of eyes with longstanding TR and CH had poor visual outcomes as defined above. Among the eyes with incident non-CMV OOI, median CD4 at diagnosis were 99, 22 and 43 cells/μL in patients with HR, TR and CH respectively. More than 50% of the eyes with HR and TR were associated with poor visual outcomes. In all groups, visual impairment occurred within the first year of diagnosis and did not progress. The mortality rates were higher among those patients who developed incident non-CMV OOI (rates=21.7, 6.4, and 12.8 deaths/100 PY for HR, TR, and CH) when compared to patients who had the OOI at enrollment (rates=3.9, 4.3, and 2.1 deaths/100 PY for HR, TR, and CH).
Non-CMV ocular opportunistic infections are associated with high rates of visual loss and systemic complications including mortality.
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