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S. Hsieh, R. M. Lieberman, D. A. Chruscicki, A. Toor, N. N. Vaidya, S. R. Oh, K. J. Zamecki, R. M. Fischer; Long-Term Follow-Up of HIV-Positive Patients With Infectious Posterior Ophthalmic Disease in a City Hospital Population. Invest. Ophthalmol. Vis. Sci. 2007;48(13):340.
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As life expectancy in HIV rises, a growing number of patients are affected by ongoing sequelae of the disease. We present long-term follow-up of HIV-positive patients with either infectious posterior ophthalmic disease or infectious central nervous system (CNS) lesion leading to visual dysfunction in an indigent clinic population.
Retrospective chart review was performed to include the following: demographics; date of presentation of ocular disease; complications; best corrected visual acuity (BCVA) at presentation and at regular intervals (2 weeks, 1 month, 3 months, then q 3-6 months until the final visit); viral load; CD4 counts; mortality.
47 patients were included; mean follow-up time was 19.8 months (range 1-91). The infectious etiologies were as follows: active cytomegalovirus retinitis (CMVR), 16 patients, 20 eyes; inactive CMVR, 8 patients, 12 eyes; ocular histoplasmosis (OH), 1 patient, 2 eyes; progressive outer retinal necrosis (PORN), 2 patients, 3 eyes; syphilis, 9 patients, 13 eyes; tuberculosis (TB), 2 patients, 2 eyes; toxoplasmosis, 5 patients, 6 eyes; and optic atrophy secondary to CNS cryptococcus or toxoplasmosis, 4 patients, 7 eyes. Significant complications included retinal detachment (RD), immune reconstitution uveitis (IRU), and macular hole. Both initial and final BCVA ranged from 20/20 to NLP. Loss of 3+ lines of vision occurred in 6.2% of patients with active CMVR, 25% with inactive CMVR, and 20% with toxoplasmosis. Median time to loss of 3+ lines was 13 months. In follow-up, 31.2% of the active CMVR patients expired, with average time to death from ocular presentation of 9 months; 12.5% of the inactive CMVR patients expired, with time to death of 40 months; 100% of patients with either OH or PORN expired, with average time to death of 2 months and 1 month respectively. Average CD4 count was calculated for each group and correlated with mortality.
BCVA was stable for patients in all 8 infectious groups, with 8.5% overall losing 3+ lines of vision and no group losing more than 1.5 lines on average. However, patients with active CMVR, PORN, toxoplasmosis, or infectious CNS lesion were more likely to present with moderate to severe visual impairment (BCVA of 20/50 or worse). Furthermore, patients with active CMVR, OH, and PORN were less likely to be alive at the end of follow-up, as well as to have lower CD4 counts at presentation. Significant complications (RD, IRU) occurred most frequently in patients with active CMVR.
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