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Li W, Wang X, Zhao L, Lin D, Yang Y, Liu Z, Wu X, Wang J, Zhu Y, Chen C, Zhang X, Wang R, Li R, Huang X, Huang W, Lin H. The value and implementation of routine ophthalmic examination in the era of HAART. EClinicalMedicine 2021; 31:100646. [PMID: 33385122 PMCID: PMC7772547 DOI: 10.1016/j.eclinm.2020.100646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The high prevalence of ocular manifestations (OMs) in patients with human immunodeficiency virus (HIV) infection and chronic diseases such as diabetes has become a global health issue. However, there is still a lack of an appropriate ophthalmic diagnostic procedure for the early detection of OMs in this population, leading to the risk of an irreversible visual impairment that substantially affects the quality of life of these patients. METHODS The Guangzhou HIV Infection Study was a retrospective study that enrolled hospitalised HIV-infected patients in Guangzhou between January 2005 and December 2016, period corresponding to the highly active antiretroviral therapy (HAART) era in China. We collected data on OMs, systemic diseases, hospitalisation, and demographic characteristics. We classified the patients into 3 groups according to the ophthalmic examination mode they underwent: the non-ophthalmologist examination group (patients hospitalised in 2005-2011 who were only treated by infectious disease physicians), the on-demand ophthalmic examination group (patients hospitalised in 2012-2013 who were referred for a consultation with an ophthalmologist), and the routine ophthalmic examination group (patients hospitalised in 2014-2016 who routinely underwent standard ophthalmic examinations). Binary logistic regression models were used to investigate the factors related to OMs. FINDINGS A total of 8,743 hospitalised HIV-infected patients were enrolled. The prevalence of detected OMs were 1.5% in the non-ophthalmologist examination group, 1.9% in the on-demand ophthalmic examination group, and 12.8% in the routine ophthalmic examination group. The odds of detection of OMs were highest in the routine ophthalmic examination group (adjusted odds ratio [aOR]=9.24, [95%CI, 6.51-13.12], compared to the non-ophthalmologist examination group). The detection of all types of OMs increased substantially, with keratitis, retinitis and vascular abnormalities increased the most (by 15.8-20.0 times). In the routine examination group, patients who were older than 50 years, males, with medical insurance, and were not resident in Guangzhou, had higher odds to have OMs. Several systemic diseases also increased the odds of OMs, with the highest odds among patients with a cytomegalovirus infection (aOR=5.59, [95%CI, 4.12-7.59]). Patients with retinitis, retinopathy and conjunctivitis had higher odds of having a CD4+ T cell counts less than 200 cells/μL compared to the patients that did not have these referred OMs. INTERPRETATION The implementation of a routine ophthalmic examination has improved the odds of OM detection by approximately 9 times and increased the diagnosis rates of all types of OMs. Therefore, we encourage all HIV-infected patients to undergo regular ophthalmic examinations. Patients with OMs, especially retinopathy and retinitis, need to be evaluated for immune function (such as CD4+ T cell counts) and systemic diseases.
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Affiliation(s)
- Wangting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Xiaoli Wang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510000, China
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Duoru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Yahan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Xiaohang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Jinghui Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Yi Zhu
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida 33136, United States
| | - Chuan Chen
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida 33136, United States
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Ruixin Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Ruiyang Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Xiaoman Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
- Center of Precision Medicine, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
- Corresponding author.
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Ausayakhun S, Lu LJ, Ausayakuhn S, Nanegrungsunk O, Apivatthakakul A, Luewattananont D, Photcharapongsakul C, Liu Y, Holland GN, Margolis TP, Heiden D, Keenan JD. Contralateral Eye Involvement and Retinal Detachment in Patients with Cytomegalovirus Retinitis Treated with Intravitreous Ganciclovir. Ocul Immunol Inflamm 2020; 29:1145-1150. [DOI: 10.1080/09273948.2020.1728344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Somsanguan Ausayakhun
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Louise J. Lu
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sakarin Ausayakuhn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Onnisa Nanegrungsunk
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Atitaya Apivatthakakul
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Dao Luewattananont
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Yingna Liu
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Gary N. Holland
- Department of Ophthalmology, Ocular Inflammatory Disease Center, UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Todd P. Margolis
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David Heiden
- Department of Ophthalmology and Pacific Vision Foundation, California Pacific Medical Center, San Francisco, California, USA
| | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
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Zhang XY, Fang F. Congenital human cytomegalovirus infection and neurologic diseases in newborns. Chin Med J (Engl) 2020; 132:2109-2118. [PMID: 31433331 PMCID: PMC6793797 DOI: 10.1097/cm9.0000000000000404] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: This review aimed to summarize research progress regarding congenital cytomegalovirus (cCMV) infection-related nervous system diseases and their mechanisms. Data sources: All literature quoted in this review was retrieved from PubMed and Web of Science using the keywords “Cytomegalovirus” and “Neurologic disease” in English. To identify more important information, we did not set time limits. Study selection: Relevant articles were selected by carefully reading the titles and abstracts. Then, different diagnosis and clinical treatment methods for human CMV infection-related neurologic diseases were compared, and the main mechanism and pathogenesis of neurologic damage caused by CMV were summarized from the selected published articles. Results: cCMV infection is a major cause of neonatal malformation. cCMV can infect the fetal encephalon during early gestation and compromise neurodevelopment, resulting in varying degrees of neurologic damage, mainly including hearing impairment, central nervous system (CNS) infection, neurodevelopmental disorders, ophthalmic complications, cerebral neoplasms, infantile autism, epilepsy, and other neurologic abnormalities. Conclusions: cCMV infection-induced neurodevelopmental abnormalities, which were directly caused by fetal encephalon infection, thus inducing neuroimmune responses to damage nerve cells. Such abnormalities were also caused by suppression of the proliferation and differentiation of neural progenitor cells by CMV's gene products. cCMV infection in the fetal encephalon can also inhibit neuronal migration and synapse formation and indirectly trigger placental inflammation and thus disrupt the oxygen supply to the fetus.
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Affiliation(s)
- Xin-Yan Zhang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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Sittivarakul W, Seepongphun U. Incidence Rates and Risk Factors for Vision Loss among AIDS-Related Cytomegalovirus Retinitis Patients in Southern Thailand. Ocul Immunol Inflamm 2017; 26:82-89. [PMID: 28323489 DOI: 10.1080/09273948.2017.1283044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe the incidence of and risk factors for visual acuity (VA) loss in patients with AIDS and cytomegalovirus (CMV) retinitis. METHODS A total of 132 patients were included. The main outcome measurements were the incidences of VA loss to ≤20/50 and ≤20/200. RESULTS The incidences of VA loss to ≤20/50 and ≤20/200 were 0.22/eye-year (EY) and 0.12/EY, respectively. Risk factors for the incidence of VA loss to ≤20/50 were low nadir CD4+ T-cell count (adjusted hazard ratio [aHR], 3.1), large area of retinitis (aHR, 3.7), and no immune recovery (IR) (aHR, 13.9). Risk factors for the incidence of VA loss to ≤20/200 were not receiving highly active antiretroviral therapy (HAART) (aHR, 4.4) and large retinitis area (aHR, 2.1). CONCLUSIONS The incidence of VA loss in eyes affected by CMV retinitis was high. The use of HAART, particularly with subsequent immune recovery, substantially reduced the incidence of VA loss.
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Affiliation(s)
- Wantanee Sittivarakul
- a Department of Ophthalmology, Faculty of Medicine , Prince of Songkla University , Hat Yai , Thailand
| | - Usanee Seepongphun
- a Department of Ophthalmology, Faculty of Medicine , Prince of Songkla University , Hat Yai , Thailand
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