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Strange Changes Deep in the Eye Linked to HIV and Possibly Hepatitis C Virus

October 17, 2013

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Putting the Findings in Context

  1. It is important to note that all of the people in the present study had previously been diagnosed with AIDS -- due to the presence of a life-threatening infection or having a CD4+ count below the 200-cell threshold. It is not clear if the study's findings are sufficiently robust that they are relevant to other people who have had AIDS but are enjoying prolonged survival thanks to ART. Also, another area of uncertainty is whether or not the findings are relevant to the average HIV-positive person taking ART who has never had AIDS.
  2. More research is necessary to determine the long-term consequences of HIV-NRD.
  3. The present study was observational in design. This means that its findings are not definitive; in other words, it cannot prove that having HIV-HCV co-infection increases the risk for HIV-NRD. What it does is raise a signal about the presence of HIV-HCV co-infection possibly being a factor for HIV-NRD. Another potential flaw is that the study was not randomized; from the start it was designed to explore trends in visual health. It may therefore have biased its recruitment by inadvertently favouring volunteers with visual problems or who were predisposed to develop such problems.
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  5. HIV-NRD seems unusually common in the present study. Other studies in other parts of the world need to be done to assess the health of the retinas of HIV-positive people. As scientists strive to better understand the potential cause(s) of HIV-NRD, there are at least several additional research issues that need to be explored, including the following:
    • Assessments of inflammation -- If inflammation does play a role in gradually degrading the retina, can anti-inflammatory agents counter this?
    • The potential role of cardiovascular disease on the retina -- This is important because at least one study has found that the tiny vessels that supply the retina with blood are not always in the best health in some people with AIDS.
    • Other health conditions -- Studies in HIV-negative people suggest that in conditions such as type 2 diabetes, kidney injury and higher-than-normal blood pressure are associated with abnormal health of blood vessels in the retina. Therefore, the impact of these other co-morbidities needs to be explored in people with HIV who might also have HIV-NRD.
    • The potential impact of other co-infections, such as syphilis, on the retina -- Rates of syphilis are high among some MSM, particularly those who are HIV positive. In part, syphilis can cause injury by triggering the onset of inflammation in affected organs and tissues. There are reports of visual damage caused by syphilis in HIV-positive people. Furthermore, there are reports of the rapid development of neurosyphilis in this population.
    • The role of gender in the development of HIV-NRD -- In the present study, it could be that women were more likely to inject street drugs than men and so gender itself may not be a risk factor but merely be a statistical mask for behaviour such as injecting drugs (IDU). Such behaviour could expose people to more germs, including HCV. However, it is also possible that gender could play an important role because generally women are more likely than men to develop certain inflammatory disorders linked to a dysfunctional immune system.


Bear in Mind

The findings from the present study are interesting -- some people who have survived long after a diagnosis of AIDS may be at increased risk for gradually thinning retinas (a condition called HIV-associated neuroretinal disorder). None of these participants have had decreased sharpness of vision so it is not clear if HIV-NRD has very serious consequences.

Researchers are not certain as to the causes of retinal thinning among some HIV-positive people and years of intensive research lies ahead to uncover possible causes. What is certain is that relatively early initiation of ART and high adherence can prevent AIDS-related diseases from ever occurring. Scientists need to assess ART users who have never had AIDS to determine if thinning retinas is also an emerging health issue for them.


References

  1. Friedman AH, Orellana J, Freeman WR, et al. Cytomegalovirus retinitis: a manifestation of the acquired immune deficiency syndrome (AIDS). British Journal of Ophthalmology.1983 Jun;67(6):372-80.
  2. Holland GN. AIDS and ophthalmology: the first quarter century. American Journal of Ophthalmology. 2008 Mar;145(3):397-408.
  3. Iragui VJ, Kalmijn J, Plummer DJ, et al. Pattern electroretinograms and visual evoked potentials in HIV infection: evidence of asymptomatic retinal and postretinal impairment in the absence of infectious retinopathy. Neurology. 1996 Dec;47(6):1452-6.
  4. Shah KH, Holland GN, Yu F, et al. Contrast sensitivity and color vision in HIV-infected individuals without infectious retinopathy. American Journal of Ophthalmology. 2006 Aug;142(2):284-92.
  5. Gabrielian A, MacCumber MM, Kukuyev A, et al. Didanosine-associated retinal toxicity in adults infected with human immunodeficiency virus. JAMA Ophthalmology. 2013 Feb;131(2):255-9.
  6. Kalyani PS, Holland GN, Fawzi AA, et al. Association between retinal nerve fiber layer thickness and abnormalities of vision in people with human immunodeficiency virus infection. American Journal of Ophthalmology. 2012 Apr;153(4):734-42, 742.e1.
  7. Goldbaum MH, Kozak I, Hao J, et al. Pattern recognition can detect subtle field defects in eyes of HIV individuals without retinitis under HAART. Graefe's Archive for Clinical and Experimental Ophthalmology. 2011 Apr;249(4):491-8.
  8. Kozak I, Sasik R, Freeman WR, et al. A degenerative retinal process in HIV-associated non-infectious retinopathy. PLoS One. 2013 Sep 17;8(9):e74712.
  9. Branch AD, Drye LT, Van Natta ML, et al. Evaluation of hepatitis C virus as a risk factor for HIV-associated neuroretinal disorder. Clinical Infectious Diseases. 2013; in press.
  10. Sullivan PS, Hamouda O, Delpech V, et al. Reemergence of the HIV epidemic among men who have sex with men in North America, Western Europe, and Australia, 1996-2005. Annals of Epidemiology. 2009 Jun;19(6):423-31.
  11. Leber A, MacPherson P, Lee BC. Epidemiology of infectious syphilis in Ottawa. Recurring themes revisited. Canadian Journal of Public Health. 2008 Sep-Oct;99(5):401-5.
  12. Sánchez C, Plaza Z, Vispo E, et al. Scaling up epidemics of acute hepatitis C and syphilis in HIV-infected men who have sex with men in Spain. Liver International. 2013 Oct;33(9):1357-62.
  13. Hughes EH, Guzowski M, Simunovic MP, et al. Syphilitic retinitis and uveitis in HIV-positive adults. Clinical & Experimental Ophthalmology. 2010 Dec;38(9):851-6.
  14. Dumaresq J, Langevin S, Gagnon S, et al. Clinical prediction and diagnosis of neurosyphilis in HIV-infected patients with early syphilis. Journal of Clinical Microbiology. 2013; in press.
  15. Centers for Disease Control and Prevention (CDC). Notes from the Field: Repeat syphilis infection and HIV coinfection among men who have sex with men - Baltimore, Maryland, 2010-2011. Morbidity and Mortality Weekly Report. 2013 Aug 16;62(32):649-50.
  16. Ho EL, Lukehart SA. Syphilis: using modern approaches to understand an old disease. Journal of Clinical Investigation. 2011 Dec;121(12):4584-92.
  17. Rondina MT, Weyrich AS, Zimmerman GA. Platelets as cellular effectors of inflammation in vascular diseases. Circulation Research. 2013 May 24;112(11):1506-19.
  18. Boilard E, Blanco P, Nigrovic PA. Platelets: active players in the pathogenesis of arthritis and SLE. Nature Reviews Rheumatology. 2012 Sep;8(9):534-42.
  19. Zamora C, Cantó E, Nieto JC, et al. Functional consequences of platelet binding to T lymphocytes in inflammation. Journal of Leukocyte Biology. 2013 Sep;94(3):521-9.
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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication CATIE News. Visit CATIE's Web site to find out more about their activities, publications and services.
 

Reader Comments:

Comment by: TonyDewitt (Newark, NJ) Thu., Nov. 14, 2013 at 3:11 pm EST
The reason for eye problems in HIV positive people is because of HTLV, which doctors refuse to discuss. Since HTLV is not being considered in HIV positive people, many strange symptoms like this go unexplained. Please ask you doctor to test you for and consider HTLV as a coinfection to HIV.

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