Ophthalmology: Anti-HIV Drugs Save Vision, Improve Outlook for AIDS Patients

In two separate studies, Johns Hopkins University researchers recently reported that highly active antiretroviral therapy saves the eyesight as well as the lives of HIV patients, and that among AIDS patients with longstanding vision problems, those who took HAART reported higher overall quality of life. The lead author on both studies was John H. Kempen, MD, PhD, assistant professor of ophthalmology and epidemiology at Johns Hopkins.

The study "Risk of Vision Loss in Patients with Cytomegalovirus Retinitis and the Acquired Immune Deficiency Syndrome" was published in the Archives of Ophthalmology (2003;121:466-476). Kempen and his team evaluated 648 AIDS patients seen at Johns Hopkins' Wilmer Eye Institute between August 1983 and March 2000. Of these, 17 percent had 20/200 vision (legal blindness), while 33 percent had 20/50 vision (poor enough to restrict their ability to drive). The patients were tracked monthly. Within the first year after being diagnosed with CMV retinitis, 56 percent had vision loss to the level of 20/50, and 37 percent were legally blind.

During follow-up, 93 patients received HAART. Of these, 46 patients had substantial improvement in their immunity, while 47 did not. Those who received HAART had a much lower incidence of visual acuity loss compared with patients who did not receive the therapy, especially those who had improvement of their immunity.

The second study, "The Effect of Cytomegalovirus Retinitis on the Quality of Life of Patients with AIDS in the Era of Highly Active Antiretroviral Therapy," was published in Ophthalmology (2003;110:987-995) and is a report from the Longitudinal Study of Ocular Complications of AIDS. Researchers at Johns Hopkins and 18 other U.S. centers questioned 971 AIDS patients ages 13 and older about their quality of life related to vision and overall health. The patients were enrolled between September 1998 and March 2001. Of the patients, 50 had newly diagnosed CMV retinitis; 212 had CMV retinitis of an average of three years' duration; and 709 had no CMV retinitis. Newly diagnosed patients tended to be younger, female and African-American. They were more likely to have detectable CMV DNA in their blood and were less likely to be taking HAART.

The longstanding and newly diagnosed CMV retinitis groups scored substantially worse in vision-related quality of life than the group without CMV retinitis. But general health-related quality of life scores for the longstanding CMV retinitis group tended to be similar to, or better than, those for patients without CMV retinitis, mostly due to the effects of HAART. Patients with newly diagnosed CMV retinitis tended to score worse on the general health-related quality of life scale.

"AIDS patients should take HAART as soon and as much as they can," Kempen said. "HAART often can save both their life and their vision."

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