1
|
Zhang P, Qian Y, Wang L, Suo J, Yin L, Wang Y, Zhang L, Wang Z. The Association of Intraocular Efavirenz Concentrations and HIV-1 Viral Load Among Persons With HIV. J Acquir Immune Defic Syndr 2024; 96:299-303. [PMID: 38534141 DOI: 10.1097/qai.0000000000003426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/20/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE Efavirenz (EFV) is commonly used in combination antiretroviral therapy. However, in our previous study, many persons living with HIV exhibited ocular complications despite undergoing effective combination antiretroviral therapy. Here, we aimed to determine the intraocular EFV concentrations in the vitreous and analyze the factors affecting viral load in the vitreous in patients with HIV-associated retinopathies. DESIGN Observational, retrospective study. METHODS Fourteen patients receiving EFV in combination with an antiretroviral therapy who underwent pars plana vitrectomy were enrolled between January 2019 and August 2022. The patients were divided into 2 groups based on presence or absence of retinal detachment (RD). Patient characteristics and HIV-1 RNA levels in plasma and vitreous were recorded during pars plana vitrectomy. Paired blood plasma and vitreous samples were obtained for EFV concentration analysis using ultra-high-performance liquid chromatography/tandem mass spectrometry. RESULTS The median age of the enrolled patients was 48 years (interquartile range, 32.25-53.25), including 12 men and 2 women. Median vitreous and plasma EFV concentrations were 141.5 (interquartile range, 69.63-323.75) and 2620 ng/mL (1680-4207.5), respectively. Median ratio of vitreous/plasma EFV concentrations in the paired samples among all participants was 0.053 (0.018-0.118). Median vitreous/plasma EFV concentrations significantly differed between the non-RD and RD groups (0.04 vs 0.12, P = 0.042). CONCLUSIONS The vitreous EFV concentrations were insufficient to inhibit viral replication in intraocular tissues, which may be because of poor penetration of the blood-retinal barrier. High vitreous EFV concentrations were associated with RD, indicating a correlation between the EFV concentration and the severity of blood-retinal barrier disruption. It implied that EFV was not a suitable antiviral drug to inhibit HIV-1 replication in ocular tissues.
Collapse
Affiliation(s)
- Pei Zhang
- Department of Ophthalmology, Huashan Hospital of Fudan University, Shanghai, China ; and
| | - Yiwen Qian
- Department of Ophthalmology, Huashan Hospital of Fudan University, Shanghai, China ; and
| | - Luoziyi Wang
- Department of Ophthalmology, Huashan Hospital of Fudan University, Shanghai, China ; and
| | - Jinshan Suo
- Department of Ophthalmology, Huashan Hospital of Fudan University, Shanghai, China ; and
| | - Lin Yin
- Department of Clinical Research Center, Shanghai Public Health Clinical Center, Fudan University
| | - Yuceng Wang
- Department of Ophthalmology, Huashan Hospital of Fudan University, Shanghai, China ; and
| | - Lijun Zhang
- Department of Clinical Research Center, Shanghai Public Health Clinical Center, Fudan University
| | - Zhiliang Wang
- Department of Ophthalmology, Huashan Hospital of Fudan University, Shanghai, China ; and
| |
Collapse
|
2
|
Kim J, Ahn SJ. Risk of Post-COVID-19 Uveitis and Risk Modification by Vaccination: A Nationwide Retrospective Cohort Study. Vaccines (Basel) 2024; 12:631. [PMID: 38932360 PMCID: PMC11209449 DOI: 10.3390/vaccines12060631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/04/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
This study aimed to evaluate the risk of uveitis, one of the most common ocular manifestations of COVID-19, in individuals with a history of uveitis and COVID-19 infection while discriminating the effects of COVID-19 infection and vaccinations. We analyzed nationwide data from 235,228 individuals with a history of uveitis prior to COVID-19 infection and evaluated incidences and hazard ratios (HRs) of post-COVID-19 uveitis for different post-infection periods, including early- (within 30 days) and delayed-onset ones. The cumulative incidences of post-infection uveitis at 3, 6, and 12 months were calculated as 8.5%, 11.8%, and 14.0%, respectively. The HR of post-COVID-19 uveitis was 1.21 (95% confidence interval [CI]: 1.07-1.37) and was particularly higher in the early-onset period (1.42, 95% CI: 1.24-1.61). Vaccinated individuals showed a modestly elevated risk of uveitis relative to pre-infection, while unvaccinated ones exhibited substantially higher risks in the early-onset period: the HR of post-infection uveitis before vaccination was 3.61 (95% CI: 1.35-9.66), whereas after vaccination, it was 1.21 (95% CI: 1.05-1.39). COVID-19 infection was associated with a higher risk of uveitis, which was mitigated by vaccination. Vigilance in the monitoring of uveitis is warranted for recently COVID-19-infected individuals with a history of uveitis, particularly unvaccinated individuals.
Collapse
Affiliation(s)
- Jiyeong Kim
- Department of Pre-Medicine, College of Medicine, and Biostatistics Laboratory, Medical Research Collaborating Center (MRCC), Hanyang University, Seoul 04763, Republic of Korea;
| | - Seong Joon Ahn
- Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| |
Collapse
|
3
|
Smit DP, Mathew DK, Khairallah M, Yeh S, Cunningham ET. A Review of Human Ocular RNA Virus Infections Excluding Coronavirus, Human T-Cell Lymphotropic Virus, and Arboviruses. Ocul Immunol Inflamm 2023; 31:1454-1460. [PMID: 37315305 DOI: 10.1080/09273948.2023.2220027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/03/2023] [Accepted: 05/26/2023] [Indexed: 06/16/2023]
Abstract
We provide an updated review of pre-selected RNA viruses causing ocular inflammation in humans. RNA viruses such as coronaviruses and arboviruses are reviewed elsewhere. A Google Scholar search was conducted to identify recent publications on ocular inflammation caused by the RNA viruses specified here. Human RNA viruses target a wide range of ocular tissues from the anterior to the posterior. Influenza, measles and mumps cause anterior segment manifestations including conjunctivitis and keratitis, while retinitis and optic neuritis may be seen posteriorly. Newcastle disease and RSV cause conjunctivitis, whereas HIV causes characteristic anterior uveitis. Cataracts, microphthalmos, and iris abnormalities are common in congenital Rubella, while Rubella virus is associated with Fuchs uveitis syndrome. Newer technologies make it possible to detect more than one pathogen if present simultaneously. RNA viruses may produce significant ocular morbidity, and care should be taken to investigate ocular symptoms during disease outbreaks.
Collapse
Affiliation(s)
- Derrick P Smit
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Dony K Mathew
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Moncef Khairallah
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Steven Yeh
- Truhlsen Eye Institute, Department of Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Emmett T Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| |
Collapse
|
4
|
Human Immunodeficiency Virus and Uveitis. Viruses 2023; 15:v15020444. [PMID: 36851658 PMCID: PMC9962278 DOI: 10.3390/v15020444] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Uveitis is one of the most common ocular complications in people living with the Human immunodeficiency virus (HIV) and can be classified into HIV-induced uveitis, co-infection related uveitis, immune recovery uveitis, and drug-induced uveitis. The introduction of antiretroviral therapy has considerably changed the incidence, diagnosis, and treatment of different types of HIV-related uveitis. Furthermore, the specific immune condition of patients infected with HIV makes diagnosing HIV-related uveitis difficult. Recent studies have focused on the growing prevalence of syphilis/tuberculosis co-infection in uveitis. Simultaneously, more studies have demonstrated that HIV can directly contribute to the incidence of uveitis. However, the detailed mechanism has not been studied. Immune recovery uveitis is diagnosed by exclusion, and recent studies have addressed the role of biomarkers in its diagnosis. This review highlights recent updates on HIV-related uveitis. Furthermore, it aims to draw the attention of infectious disease physicians and ophthalmologists to the ocular health of patients infected with HIV.
Collapse
|
5
|
Di Y, Yu W, Ye J. Temporal trends in ocular manifestations of HIV/AIDS patients in the past 18 years in a tertiary hospital in China. Graefes Arch Clin Exp Ophthalmol 2022; 260:2807-2818. [PMID: 35460364 DOI: 10.1007/s00417-022-05660-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 03/30/2022] [Accepted: 04/08/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To investigate the ocular manifestation changes in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patents in a tertiary eye clinic in China over the past 18 years. METHODS In this retrospective cross-sectional study, 264 HIV/AIDS patients (528 eyes) were recruited at the Department of Ophthalmology, Peking Union Medical College Hospital, from 2001 to 2018. Patients underwent ophthalmic examinations, including best-corrected visual acuity (BCVA), slit-lamp microscopy, and indirect ophthalmoscopy, and completed a registration form including demographic characteristics, medical history, and immune status data. Kruskal-Wallis test or Mann-Whitney test was used to compare continuous variables, and Pearson's chi-squared test or Fisher's exact test was performed to compare categorical variables. RESULTS Regarding demographic characteristics, there was a significant increasing trend in male patients, sexual transmission, and HIV/AIDS-syphilis coinfection (all P < 0.001). For systemic features, more patients received cART, and fewer patients had systemic syndromes after 2003 (P < 0.001). For ocular manifestations, there were no significant changes between time intervals in CMVR and HIV retinopathy patients (P = 0.149, P = 0.643), but the proportion of patients with uveitis increased from 1.14% to 19.32% (P < 0.001). CONCLUSION CMVR was the most common ocular compilation in HIV/AIDS patients, followed by uveitis and HIV retinopathy. The proportion of patients with CMVR and HIV retinopathy was stable over time, but the proportion of patients with uveitis showed a significant increasing trend. Therefore, immediate ophthalmic examination should be performed at the point of care or as soon as possible after entry into the health care system.
Collapse
Affiliation(s)
- Yu Di
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Weihong Yu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Junjie Ye
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China. .,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| |
Collapse
|
6
|
Human Immunodeficiency Virus Infection Increases the Risk of Incident Uveitis Among People Living With HIV/AIDS. J Acquir Immune Defic Syndr 2019; 79:149-157. [PMID: 30212432 DOI: 10.1097/qai.0000000000001782] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Case reports indicated that HIV itself may be a direct cause of uveitis. However, the association of HIV with incident uveitis has not been extensively studied. This nationwide cohort study determined the association of HIV with incident uveitis. METHODS Since January 1, 2003, we identified adult people living with HIV/AIDS (PLWHA) from Taiwan Centers for Disease Control HIV Surveillance Database. A control cohort without HIV infection, matched for age and sex, was selected for comparison from the Taiwan National Health Insurance Research Database. The time-dependent Cox proportional hazards model was used to determine the associations of HIV and highly active antiretroviral therapy (HAART) with incident uveitis, while considering death as a competing risk event. RESULTS Of the total 120,430 patients (24,086 PLWHA and 96,344 matched controls), 609 (0.51%) had incident uveitis, including 334 (1.39%) PLWHA and 265 (0.28%) controls. After adjusting for age, sex, and comorbidities, HIV infection was found to be an independent risk factor for incident uveitis [adjusted hazard ratio (AHR), 5.55; 95% confidence interval (CI): 4.67 to 6.59]. Within PLWHA, the risk of incident uveitis was significantly higher in those who received HAART (AHR, 2.46; 95% CI: 1.71 to 3.54). In addition, considering the short- and long-term effects of HAART on incident uveitis, HAART was found to associate with a higher risk of uveitis development within 1 year of treatment (AHR, 3.36; 95% CI: 2.41 to 4.69), but not after 1 year of HAART initiation (AHR, 1.14; 95% CI: 0.76 to 1.72). CONCLUSIONS HIV infection is an independent risk factor for incident uveitis.
Collapse
|
7
|
Onda M, Niimi Y, Ozawa K, Shiraki I, Mochizuki K, Yamamoto T, Sugita S, Ishida K. Human Herpesvirus-6 corneal Endotheliitis after intravitreal injection of Ranibizumab. BMC Ophthalmol 2019; 19:19. [PMID: 30651089 PMCID: PMC6335734 DOI: 10.1186/s12886-019-1032-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 01/08/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND To report the first case of human herpesvirus-6 (HHV-6) corneal endotheliitis that developed after intravitreal ranibizumab injections. CASE PRESENTATION A 63-year-old man with a medical history of diabetes and systemic steroid treatment for bullous pemphigoid had been receiving intravitreal injections of ranibizumab in the left eye for 2 years according to a Pro Re Nata treatment regimen for macular edema associated with branch retinal vein occlusion. Twenty days after the last injection, the patient presented with pain and decreased visual acuity in his left eye. His best corrected visual acuity in the left eye was 2/200, and intraocular pressure was 45 mmHg with edema of the central stromal cornea, mild conjunctival injection, intermediate keratic precipitates, and mild anterior chamber reaction. HHV-6 DNA was detected in the aqueous humor using multiplex strip polymerase chain reaction, and it was identified as variant A, HHV-6A. A diagnosis of HHV-6A-associated corneal endotheliitis was made. Oral valganciclovir and topical ganciclovir therapy was initiated with good resolution of all symptoms and signs. CONCLUSIONS HHV-6A can be a possible complication of intravitreal ranibizumab therapy. To the best of our knowledge, this is the first reported case of HHV-6A corneal endotheliitis following intravitreal ranibizumab injection.
Collapse
Affiliation(s)
- Masahiro Onda
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu, 501-1194, Japan
| | - Yusuke Niimi
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu, 501-1194, Japan
| | - Kenji Ozawa
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu, 501-1194, Japan
| | - Ikumi Shiraki
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu, 501-1194, Japan
| | - Kiyofumi Mochizuki
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu, 501-1194, Japan
| | - Tetsuya Yamamoto
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu, 501-1194, Japan
| | - Sunao Sugita
- Laboratory for Retinal Regeneration, Riken Center for Developmental Biology, Kobe, Japan
| | - Kyoko Ishida
- Department of Ophthalmology, Toho University Ohashi Medical Center, 2-22-36, Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.
| |
Collapse
|
8
|
Selvaraj JR, Sudharshan S, Therese LK, Janani MK, Selvamuthu P, Rewri P, Biswas J. Real-time polymerase chain reaction for diagnosis and management of HIV-induced uveitis. Indian J Ophthalmol 2018; 66:1634-1636. [PMID: 30355888 PMCID: PMC6213659 DOI: 10.4103/ijo.ijo_509_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intraocular (IO) inflammation in patients with Human immune deficiency virus (HIV) infection can be due to opportunistic infections, immune recovery uveitis, drugs used in the management or a primary manifestation of HIV itself. We studied the role of RT-PCR for HIV RNA in confirming the diagnosis of HIV induced uveitis and its useful in the management and follow-up of these patients.
Collapse
Affiliation(s)
- Jayapratha R Selvaraj
- Department of Uveitis and intra-ocular inflammation, Medical Research Foundation, Sankara Netharalaya, Chennai, Tamil Nadu, India
| | - S Sudharshan
- Department of Uveitis and intra-ocular inflammation, Medical Research Foundation, Sankara Netharalaya, Chennai, Tamil Nadu, India
| | - Lily K Therese
- Department of Microbiology Vision Research Foundation, Sankara Netharalaya, Chennai, Tamil Nadu, India
| | - M K Janani
- Department of Microbiology Vision Research Foundation, Sankara Netharalaya, Chennai, Tamil Nadu, India
| | | | - Parveen Rewri
- Maharaja Agrasen Medical College, Hisar, Haryana, India
| | - Jyotirmay Biswas
- Department of Uveitis and intra-ocular inflammation, Medical Research Foundation, Sankara Netharalaya, Chennai, Tamil Nadu, India
| |
Collapse
|
9
|
Groen-Hakan F, Babu K, Tugal-Tutkun I, Pathanapithoon K, de Boer JH, Smith JR, de Groot-Mijnes JD, Rothova A. Challenges of Diagnosing Viral Anterior Uveitis. Ocul Immunol Inflamm 2017; 25:710-720. [DOI: 10.1080/09273948.2017.1353105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Fahriye Groen-Hakan
- Department of Ophthalmology, Faculty of Medicine, Erasmus University, Rotterdam, The Netherlands
| | - Kalpana Babu
- Prabha Eye Clinic & Research Centre, Vittala International Institute of Ophthalmology, Bangalore, India
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kessara Pathanapithoon
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Joke H. de Boer
- Department of Ophthalmology, Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Justine R. Smith
- Eye & Vision Health, Flinders University School of Medicine, Adelaide, Australia
| | | | - Aniki Rothova
- Department of Ophthalmology, Faculty of Medicine, Erasmus University, Rotterdam, The Netherlands
| |
Collapse
|
10
|
Abstract
OBJECTIVE To analyze and compare HIV-1 env sequences from the eye to those from the blood of individuals with uveitis attributed to HIV with the goal of gaining insight into the pathogenesis of HIV-associated eye disease. DESIGN A prospective case series of five HIV-infected antiretroviral-naive individuals with uveitis negative for other pathogens. METHODS RNA from blood plasma and ocular aqueous humor was reverse transcribed using random hexamers. HIV env C2-V5 (HXB2: 6990-7668) sequences were generated by single-genome amplification using nested polymerase chain reaction followed by bidirectional Sanger sequencing. Sequence analyses by Geneious, Geno2Pheno, N-GLYCOSITE, DIVEIN, and HyPhy evaluated relationships between HIV in plasma and aqueous humor. RESULTS A median of 20 (range: 13-22) plasma and 15 (range: 9-18) aqueous humor sequences were generated from each individual. The frequencies of sequences with predicted-N-linked-glycosylation sites and C-X-C chemokine receptor type 4 were comparable in aqueous humor and plasma of all five patients. Aqueous humor sequences had lower median genetic diversity compared with plasma across all patients, but similar divergence, in four of five patients. Aqueous humor HIV sequences were compartmentalized from plasma across subjects by Critchlow correlation coefficient, Slatkin and Maddison, nearest-neighbor statistic, and Fixation index. CONCLUSION Among antiretroviral-naive individuals with uveitis attributed to HIV, the universal compartmentalization and decreased diversity of eye compared with blood sequences suggests time-limited passage of a small subset of variants from each patient's viral population into the eye tissues, followed by limited immune selection despite the inflammatory uveitis.
Collapse
|
11
|
|
12
|
Gerber WM, Meyer D, Smit DP. Ocular and Cerebrospinal Fluid Penetration of Antiretroviral Agents. J Ocul Pharmacol Ther 2016; 32:476-81. [PMID: 27309632 DOI: 10.1089/jop.2015.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The ocular penetration of systemically administered antiretroviral drugs (ARVs), which is important in the clinical setting of HIV uveitis, is unknown. This study aimed to assess the ocular penetration of different antiretroviral drugs in an animal model. METHODS Twenty-five male New Zealand white rabbits were assigned to one of five treatment groups. Each group received a single oral dose of an antiretroviral drug (lamivudine, tenofovir, efavirenz, lopinavir, and raltegravir). These 5 drugs represent 4 different ARV drug classes [nucleoside reverse transcriptase inhibitors (NRTI), non-NRTI, protease inhibitors, and integrase inhibitors]. Serum, cerebrospinal fluid (CSF), and aqueous and vitreous humor samples were collected at the time of theoretical maximum serum concentration of each respective drug, for example, lamivudine 1 h, tenofovir 1 h, efavirenz 5 h, lopinavir 4 h, and raltegravir 3 h. The drug concentration in each sample was determined by means of high-performance liquid chromatography and mass spectrometry. RESULTS After a single oral dose, measurable levels of all five ARVs administered could be detected in all 4 body compartments. The limit of detection based on a signal-to-noise ratio of 1:3 for the antiretroviral agents was as follows: 1 part per billion (ppb) for lamivudine, tenofovir, and efavirenz and 0.1 ppb for lopinavir and raltegravir. The IC50 (inhibitory concentration where 50% of viral replication is inhibited by a drug) was reached for all drugs in the serum and CSF. In the aqueous humor, lopinavir failed to reach IC50 and in the vitreous humor, only efavirenz and lopinavir attained IC50 levels. CONCLUSION After a single oral dose, measurable levels of all 4 classes of ARVs could be detected in all 4 body compartments sampled. In the eye, IC50 levels were lower in the vitreous humor than in aqueous humor. IC50 levels in the serum were higher than in the CSF.
Collapse
Affiliation(s)
- Willem-Martin Gerber
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa
| | - David Meyer
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa
| | - Derrick P Smit
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa
| |
Collapse
|
13
|
Clinical manifestations of human immunodeficiency virus-induced uveitis. Ophthalmology 2012; 119:1455-9. [PMID: 22542726 DOI: 10.1016/j.ophtha.2012.01.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 01/13/2012] [Accepted: 01/17/2012] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To describe the clinical manifestations of patients with human immunodeficiency virus (HIV)-induced uveitis in Thailand. DESIGN Prospective cohort study of 6 patients with HIV-induced uveitis. PARTICIPANTS Six patients (8 eyes) with HIV-induced uveitis who had an extremely high intraocular: plasma HIV-1 RNA ratio. METHODS The clinical manifestations and laboratory findings are reported of 6 consecutive patients with HIV-induced uveitis who had an extremely high intraocular-to-plasma HIV-1 RNA ratio and were diagnosed between July 2009 and May 2011. MAIN OUTCOME MEASURES Clinical manifestations and laboratory findings. RESULTS Human immunodeficiency virus-induced uveitis was diagnosed in 4 men and 2 women with an average age of 41 years at presentation. None of the patients were receiving highly active anti-retroviral therapy (HAART) or had clinical or laboratory evidence, or both, of opportunistic infections. The mean plasma load was 218 688 copies/ml (median, 137 500 copies/ml; range, 24 900-540 000 copies/ml), and the mean intraocular HIV load was 20 937 755 copies/ml (median, 7 499 000 copies/ml; range, 2 460 000-89 800 000 copies/ml). The average CD4 cell count was 192 cells/μl (median, 248 cells/μl; range, 5-342 cells/μl). All the patients had decreased vision, and none had conjunctival hyperemia. The anatomic location of uveitis was anterior in all patients, and associated vitreitis was present in 4 patients; none exhibited retinal lesions or scars. Anterior segment inflammation and keratic precipitates were observed in all patients, and none responded to topical corticosteroid therapy. After the administration of HAART, the intraocular inflammation disappeared entirely within several weeks in all of the patients and the intraocular and plasma HIV loads decreased. CONCLUSIONS Human immunodeficiency virus-induced uveitis should be suspected in HAART-naïve, HIV-positive patients or in those in whom this treatment fails and who have anterior uveitis without any retinal lesions and exhibit no response to topical corticosteroids. The concurrent determination of HIV load in the intraocular fluids and plasma may clarify the cause of HIV-associated uveitis.
Collapse
|
14
|
Stewart MW. Human immunodeficiency virus and its effects on the visual system. Infect Dis Rep 2012; 4:e25. [PMID: 24470932 PMCID: PMC3892652 DOI: 10.4081/idr.2012.e25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 02/05/2012] [Accepted: 02/06/2012] [Indexed: 12/13/2022] Open
Abstract
During the first 15 years of the AIDS epidemic patients experienced a high incidence of blindness due to cytomegalovirus (CMV) retinitis and other severe ocular opportunistic infections. Highly active anti-retroviral therapy, introduced in 1996, dramatically decreased the incidence of CMV retinitis. Though CMV retinitis still causes 40% of vision loss in AIDS patients, other conditions such as immune reconstitution uveitis, cataracts, and a significant othercategory -which most investigators believe is directly due to HIV - comprise the majority of cases. HIV causes vascular abnormalities of the conjunctiva and retina in the majority of AIDS patients, as well as retinitis, anterior and posterior uveitis and vasculitis. HIV frequently causes an optic neuropathy and is responsible for the majority of eye movement disorders among HIV patients. Physicians need to be aware that these problems may be the initial manifestation of HIV infections or a sign of highly active anti-retroviral therapy (HAART) failure. Therefore, patients with identifiable risk factors for AIDS who present with ophthalmologic conditions of unknown etiology should be considered for HIV testing. Finally, anti-retroviral therapy has been reported to cause asymptomatic deposits as well as degenerative conditions of both the anterior and posterior segments of the eye.
Collapse
Affiliation(s)
- Michael W Stewart
- Department of Ophthalmology, Mayo College of Medicine, Jacksonville, FL, USA
| |
Collapse
|
15
|
Rasmussen LD, Kessel L, Molander LD, Pedersen C, Gerstoft J, Kronborg G, Obel N. Risk of cataract surgery in HIV-infected individuals: a Danish Nationwide Population-based cohort study. Clin Infect Dis 2011; 53:1156-63. [PMID: 21998282 DOI: 10.1093/cid/cir675] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Premature aging has been suggested a risk factor for early death in patients infected with human immunodeficiency virus (HIV). Therefore, the risk of age-related diseases, such as cataracts, should be increased in this population. In a nationwide, population-based cohort study we assessed the risk of cataract surgery in HIV-infected individuals compared with the general population. METHODS We identified 5315 HIV-infected individuals from a Danish national cohort of HIV-infected individuals and a population-based age- and sex-matched comparison cohort of 53,150 individuals. Data on cataract surgery were obtained from the Danish National Hospital registry. Cumulative incidence curves were constructed. Incidence rate ratios (IRRs) and impact of immunodeficiency, highly active antiretroviral therapy (HAART), and treatment with abacavir, tenofovir, protease inhibitors, and nonnucleoside analogue reverse-transcriptase inhibitors (NNRTIs) were estimated by Poisson regression analyses and adjusted for age, sex, and calendar year. RESULTS HIV-infected individuals had a higher risk of cataract surgery than the comparison cohort (adjusted IRR, 1.87; 95% confidence interval (CI): 1.50-2.33). The highest risk was found in patients with a CD4 cell count ≤ 200 cells/μL (adjusted IRR before HAART initiation, 3.11 [95% CI, 1.26-7.63]; adjusted IRR after HAART initiation, 4.74 [95% CI, 2.60-8.62]). In patients not receiving HAART and those receiving HAART with a CD4 cell count >200 cells/mL the adjusted IRRs were 0.60 (95% CI: 0.22-1.61) and 1.87 (95% CI: 1.46-2.39). Treatment with abacavir, tenofovir, protease inhibitors, or NNRTIs did not increase the risk substantially. CONCLUSIONS HIV-infected individuals have an increased risk of cataract surgery. The risk is mainly associated with immunodeficiency and HAART, but accelerated aging cannot be excluded as part of the possible explanation.
Collapse
Affiliation(s)
- Line D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, Denmark.
| | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
OBJECTIVE The objective of this study was to analyze human immunodeficiency virus (HIV) dynamics across the blood-retinal barrier and to determine whether the high levels of HIV in the eye are associated with any ocular disorders in HIV-infected patients. DESIGN This study included a prospective case series of 40 HIV-positive patients with uveitis. INTERVENTION Clinical and laboratory examinations included plasma and intraocular HIV-1 RNA loads as well as the clinical manifestations of uveitis. RESULTS Intraocular HIV-1 RNA was detected in 32% (13/40) of HIV-positive patients with uveitis. Intraocular HIV-1 RNA loads were associated with high HIV-1 RNA plasma loads (P < 0.001) and not being on HAART therapy (P = 0.005). In addition, detectable intraocular HIV-1 RNA levels were higher in patients with the absence of retinal lesions (P = 0.008). In three patients, the HIV load in the eye largely exceeded that of plasma. These three patients had all bilateral anterior uveitis and/or vitritis without retinal lesions and exhibited no evidence of other intraocular infectious agents causing uveitis than HIV itself. CONCLUSION The eye can form a sanctuary where HIV might replicate and cause an inflammatory reaction.
Collapse
|