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Cytomegalovirus Retinitis in Patients with AIDS before and after Introduction of HAART in China. Eur J Ophthalmol 2018; 24:209-15. [PMID: 24030539 DOI: 10.5301/ejo.5000354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2013] [Indexed: 11/20/2022]
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Huang YM, Hong XZ, Xu JH, Luo JX, Mo HY, Zhao HL. Autoimmunity and dysmetabolism of human acquired immunodeficiency syndrome. Immunol Res 2017; 64:641-52. [PMID: 26676359 DOI: 10.1007/s12026-015-8767-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Acquired immunodeficiency syndrome (AIDS) remains ill-defined by lists of symptoms, infections, tumors, and disorders in metabolism and immunity. Low CD4 cell count, severe loss of body weight, pneumocystis pneumonia, and Kaposi's sarcoma are the major disease indicators. Lines of evidence indicate that patients living with AIDS have both immunodeficiency and autoimmunity. Immunodeficiency is attributed to deficits in the skin- and mucosa-defined innate immunity, CD4 T cells and regulatory T cells, presumably relating human immunodeficiency virus (HIV) infection. The autoimmunity in AIDS is evident by: (1) overproduction of autoantibodies, (2) impaired response of CD4 cells and CD8 cells, (3) failure of clinical trials of HIV vaccines, and (4) therapeutic benefits of immunosuppression following solid organ transplantation and bone marrow transplantation in patients at risk of AIDS. Autoantibodies are generated in response to antigens such as debris and molecules de novo released from dead cells, infectious agents, and catabolic events. Disturbances in metabolic homeostasis occur at the interface of immunodeficiency and autoimmunity in the development of AIDS. Optimal treatments favor therapeutics targeting on the regulation of metabolism to restore immune homeostasis.
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Affiliation(s)
- Yan-Mei Huang
- Department of Immunology, Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China
| | - Xue-Zhi Hong
- Department of Immunology, Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China. .,Department of Rheumatology and Immunology, The Affiliated Hospital of the Guilin Medical University, Guilin, 541004, China.
| | - Jia-Hua Xu
- Fangchenggang Hospital of Traditional Chinese Medicine, Fangchenggang, 538021, Guangxi, China
| | - Jiang-Xi Luo
- Department of Immunology, Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China
| | - Han-You Mo
- Department of Rheumatology and Immunology, The Affiliated Hospital of the Guilin Medical University, Guilin, 541004, China
| | - Hai-Lu Zhao
- Department of Immunology, Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of Basic Medicine, Guilin Medical University, Guilin, 541004, China
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Miller C, Short WR, Perez-Povis L, Lontok J, Fecarotta C, Liu M, Sendecki J, Belden K. The spectrum of eye disease in hospitalized adults living with HIV, 1995-2010. AIDS Patient Care STDS 2014; 28:47-55. [PMID: 24491190 DOI: 10.1089/apc.2013.0258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Eye disease is a well-documented complication of HIV infection. Opportunistic infections generally comprised the majority of pre-antiretroviral therapy (ART) eye complications. With the introduction of ART, opportunistic infections diminished. However, early ART regimens were cumbersome regarding side effects and pill burden, making patient compliance difficult. Newer ART regimens are better tolerated and consist of fewer pills, theoretically making compliance easier and therapy more effective. The aim of this chart review study is to examine eye disease epidemiology in HIV patients as ART has evolved. We reviewed 222 admissions at Thomas Jefferson University Hospitals for 188 patients. These cases were divided into two groups. The first group was comprised of patients admitted from 1995 through 2003, while the second group consisted of patients admitted from 2003 to 2010. Eye disease epidemiology was compared between the two groups. Our study did note a significant decrease in eye diseases caused by opportunistic infections in the 2003-2010 patient group. Noninfectious eye disease is a significant complication in this group.
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Affiliation(s)
- Christopher Miller
- Division of Infectious Diseases, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - William R. Short
- Division of Infectious Diseases, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
- Jefferson Medical College of Thomas Jefferson University
| | - Lorena Perez-Povis
- Division of Infectious Diseases, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
- Shannon Clinic and Shannon Medical Center, San Angelo, Texas
| | - Josephine Lontok
- Division of Infectious Diseases, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Christopher Fecarotta
- Wills Eye Institute, Philadelphia, Pennsylvania; and Nemours/AI Dupont Hospital for Children, Wilmington, Delaware
| | - Mengdan Liu
- Center for Research in Medical Education and Health Care, Jefferson Medical College, Philadelphia, Pennsylvania
| | - Jocelyn Sendecki
- Division of Biostatistics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Katherine Belden
- Division of Infectious Diseases, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
- Jefferson Medical College of Thomas Jefferson University
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Wang Z, Jia R, Ge S, He T, Zhang Y, Yang Y, Wang Y, Shi W, Ji Y, Ye F, Chen P, Lu J, Sun J, Xu X, Zhou Y, Gu P, Luo M, Lu H, Fan X. Ocular complications of human immunodeficiency virus infection in eastern china. Am J Ophthalmol 2012; 153:363-369.e1. [PMID: 21982101 DOI: 10.1016/j.ajo.2011.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 07/29/2011] [Accepted: 07/30/2011] [Indexed: 11/15/2022]
Abstract
PURPOSE To investigate ocular complications in patients with HIV/AIDS in eastern China during the time of highly active antiretroviral therapy (HAART). DESIGN Prospective study. METHODS This study was carried out from August 1, 2009 to July 31, 2010. Recruited HIV/AIDS patients underwent a series of surveys and ophthalmologic and laboratory examinations (including CD4 level) at enrollment. RESULTS In this study, all 787 HIV/AIDS patients (1574 eyes) had a history of HAART. Of these patients, 28.72% (95% CI = 0.26-0.32) had a history of systemic disease and 26.30% (95% CI = 0.23-0.29) had ocular complications. Of these ocular complications, cytomegalovirus retinitis (CMVR) had the highest prevalence (10.6%, 83/787) and ocular microangiopathy had the second-highest prevalence (9.4%, 74/787). Among the patients with CMVR, 16.9% (14/83) suffered from immune recovery uveitis (IRU). Furthermore, 3.4% (27/787) of the recruited AIDS patients had neuro-ophthalmologic disorders. The mean logMAR visual acuity of the group with ocular complications was 0.47 ± 0.64, which was significantly different from the asymptomatic group (0.17 ± 0.39, P < .001). The median CD4 T-cell count of the group with ocular complications is 43 cells/μL, which was significantly different from the asymptomatic group (116.5 cells/μL, P < .001). CONCLUSIONS The study shows a high rate of treatable ocular complications among patients with HIV/AIDS in eastern China. HIV/AIDS treatment programs in China must be prepared to identify ocular complications and refer patients to the correct treatment facilities.
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Affiliation(s)
- Zhiliang Wang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, PR China
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Yoganathan K, Austin M. Ischemic maculopathy in zidovudine-induced anemia in an HIV-positive man. Clin Ophthalmol 2011; 2:237-9. [PMID: 19668413 PMCID: PMC2698697 DOI: 10.2147/opth.s2449] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Opportunistic cytomegalovirus (CMV) infection is common in severely immunocompromised HIV-positive patients. The retina is the commonest site of involvement with hemorrhages a prominent feature. CMV retinitis affects 40% of HIV positive patients who have CD4 count of less than 100 cell/mm(3), and in these circumstances clinicians are likely to consider commencing anti-CMV therapy without considering other causes. We report a man with HIV who developed bilateral retinal hemorrhages and ischemic maculopathy in association with zidovudine (AZT)-induced anemia. Retinal hemorrhages resolved following blood transfusion.
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Affiliation(s)
- Kathir Yoganathan
- Department of Genito-Urinary Medicine, Singleton Hospital, Sketty, Swansea, UK.
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Upadhyay AK, Vichare N. Ocular Lesions Associated with Human Immunodeficiency Virus Infection. Med J Armed Forces India 2010; 66:235-8. [PMID: 27408309 DOI: 10.1016/s0377-1237(10)80045-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 05/11/2010] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION This study was undertaken to document the various ocular manifestations in human immunodeficiency virus (HIV) infected individuals and to correlate such findings with CD4+ T lymphocyte levels in individuals with ocular manifestations. METHODS A total of 150 patients known to be HIV positive referred to a tertiary level army hospital were included in this cross sectional study. All patients underwent complete ophthalmic evaluation. CD4+ count was done only in patients in whom ocular lesions were noted. RESULT Most patients (54.66%) were in the 31-40 years age group. Majority of patients (84.66%) were males. Infection was sexually acquired in 91.33% by heterosexual mode. Majority of cases (34%) examined had presented within 12-18 months of being detected positive for HIV. Ocular involvement was present in 76 (50.66%) cases and the commonest ocular lesion encountered was cytomegalovirus (CMV) retinitis in 23 (30.26%) cases. CD4+ count less than 50 cells/µl was consistently associated with ocular manifestations in 36.84% of HIV positive patients. CONCLUSION This study showed the whole spectrum of ocular lesions in HIV positive cases from CMV retinitis to adnexal lesions. No case of ocular Kaposi's sarcoma was seen in this study.
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Affiliation(s)
- A K Upadhyay
- Senior Advisor (Ophthalmology), AFCME, Subroto Park, Delhi Cantt-10
| | - N Vichare
- Graded Specialist (Ophthalmology), Base Hospital, Delhi Cantt-10
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Kompella UB, Aukunuru JV, Betageri GV. Effect of Neutral Liposomes on Corneal and Conjunctival Transport of Didanosine. Drug Deliv 2008. [DOI: 10.1080/107175499267101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Wang J, You Q, Yang H, Li H, Wu H, Xu L, Jonas JB. Retinal Findings in Chinese Patients with HIV Infection. Ophthalmic Res 2008; 40:98-100. [DOI: 10.1159/000113888] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 06/25/2007] [Indexed: 11/19/2022]
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dos Santos SDS, Almeida GM, Monteiro ML, Gemignani P, Duarte MI, Toscano CM, Barone AA. Ocular myositis and diffuse meningoencephalitis from Trypanosoma cruzi in an AIDS patient. Trans R Soc Trop Med Hyg 1999; 93:535-6. [PMID: 10696415 DOI: 10.1016/s0035-9203(99)90370-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- S de S dos Santos
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de São Paulo, Brazil
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Jaffar S, Ariyoshi K, Frith P, Okouchi Y, Sabally S, Ajewole T, Bailey R, Lee PS, Corrah T, Johnson G, Faal H, Whittle H. Retinal manifestations of HIV-1 and HIV-2 infections among hospital patients in The Gambia, west Africa. Trop Med Int Health 1999; 4:487-92. [PMID: 10470340 DOI: 10.1046/j.1365-3156.1999.00425.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In developed countries, 50-75% of AIDS patients develop retinal complications and about 20-40% acquire cytomegalavirus (CMV) retinitis. We conducted a cross-sectional survey to determine prevalence of these in The Gambia where both HIV-1 and HIV-2 infection are present and the prevalence of HIV-1 is rising. METHOD All patients attending hospital whose percentage CD4+ cells (CD4%) was below 14, the level associated typically with an AIDS diagnosis, and one half of those whose CD4% was 14 or above were asked to join the study. Fifty-six HIV-1, 52 HIV-2 and 12 dually infected patients were recruited. Photographs of the fundi were taken and interpreted independently. The findings were related to the patients' percentage CD4+ cells. RESULTS The CD4% was < 14 in 40 patients and < 7 in 17 patients. Thirty-six patients were male. No cases of CMV retinitis were found. Four patients whose CD4% were 4, 5, 11 and 23 had cotton wool spots ranging in number from 1 to 14 for any one patient. The prevalence of cotton wool spots was 8% (95% CI, 0-16%) among patients with CD4% below 14 and 12% (95% CI, 0-27) among patients with CD4% below 7. One of the 4 patients had associated microaneurysm and blot haemorrhages typical of more advanced HIV microvasculopathy. CONCLUSION CMV retinitis is less common in The Gambia than in developed countries. Non-infectious retinopathy may also be less common.
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Affiliation(s)
- S Jaffar
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK.
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Plummer DJ, Sample PA, Freeman WR. Visual dysfunction in HIV-positive patients without infectious retinopathy. AIDS Patient Care STDS 1998; 12:171-9. [PMID: 11361931 DOI: 10.1089/apc.1998.12.171] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Persons with HIV disease are susceptible to various manifestations of retinal damage, such as infectious retinopathies (e.g., cytomegalovirus [CMV] retinitis and toxoplasmosis) and noninfectious complications (microangiopathic infarctions or cotton-wool spots [CWS]); CWS being quite common in AIDS patients. Until recently, little research focused on noninfectious ocular pathology in HIV disease. These disorders may all affect normal functioning of the visual system while funduscopic examination results appear normal. A review of the psychophysical changes, color and contrast sensitivity, peripheral visual function, electrophysiologic and morphologic changes, the relationship of vision loss and neuropsychological changes, postretinal damage, and imaging capabilities cast important new light on quality of life issues and vision function for all HIV/AIDS patients regardless of CD4 count, other measures of wellness, or treatment protocols. Entopic perimetry, a low-cost psychophysical technique screening test, allows sensitive and specific identification of very peripheral areas of visual field loss. The authors recommend its implementation and use by primary care providers, particularly for early detection of retinal damage when funduscopic examination results may appear normal.
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Affiliation(s)
- D J Plummer
- Department of Ophthalmology, Shiley Eye Center, University of California at San Diego, La Jolla, USA
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