When should HIV-patients have an eye examination? Screening parameters for CMV-retinitis
When should HIV-patients have an eye examination? Screening parameters for CMV-retinitis
复制标题
DOI：
10.1055/s-2008-1035281
复制
发表时间：
1996-08-01
影响因子：
0.8
通讯作者：
Hansen, LL
中科院分区：
文献类型：
--
作者：
Gellrich, MM;Lagreze, WD;Hansen, LL
背景为了减少在医生的频繁访问的负担，我们已经检查（I）在HIV感染筛查的无症状患者的眼部表现是值得的和（II）哪些参数可能表明患者在CMV-retinitis.Patients和方法的风险的215例HIV感染者的临床资料进行了回顾性分析。只有那些（a）危及视力，（B）可治疗，（c）可足够早诊断和（d）常见的眼部表现被认为适合筛查。此外，（1）CDC-阶段，（2）CD 4+计数，（3）HIV-视网膜病变，（4）CMV-尿和（5）CMV-抗体的有用性进行了检查，以表明患者在CMV-retinitis.Results无症状的HIV-患者的眼科筛查应集中在巨细胞病毒（CMV）-视网膜炎，因为这种常见的致盲性疾病的早期诊断改善视力的结果。215例HIV感染者中有85例CD 4+细胞计数低于50个/μ l。25%的患者发生CMV视网膜炎（21/85）。当低CD 4+细胞计数伴CMV尿时，CMV视网膜炎的风险上升至38%（13/34）。当HIV视网膜病变被早期诊断时，CMV视网膜炎患者的比例并没有增加（12/48 = 25%）。结论对于无眼部症状的HIV感染者，建议采用以下眼科筛查方案：（1）CD 4+细胞计数< 100个/μ l者每3个月复查一次;（2）CD 4+细胞计数< 100个/μ l者每3个月复查一次
Background To reduce the burden of frequent visits at the physician we have checked (I) for which ocular manifestations in HIV-infection screening of asymptomatic patients is worthwhile and (II) which parameters may indicate patients at risk for CMV-retinitis.Patients and Methods The clinical data of 215 HIV-infected patients were analyzed retrospectively. Only those ocular manifestations were considered suitable for screening that (a) endanger vision, (b) are treatable, (c) can be diagnosed sufficiently early and (d) are common. Furthermore (1) CDC-stage, (2) CD4+ count, (3) HIV-retinopathy, (4) CMV-uria and (5) CMV-antibodies were checked for their usefulness in indicating patients at risk for CMV-retinitis.Results Ophthalmological screening of asymptomatic HIV-patients should focus on cytomegalovirus (CMV)-retinitis because early diagnosis of this common blinding disease improves the visual outcome. 85 of 215 HIV-infected patients had a CD4+ count less than 50 cells/mu l. 25% of these patients developed CMV-retinitis (21/85). The risk for CMV retinitis rose to 38% (13/34) when the low CD4+ count was accompanied by CMV-uria. The proportion of patients with CMV-retinitis did not increase when HIV-retinopathy had been diagnosed earlier (12/48 = 25%). CMV-serology and CDC-classification were not helpful in screening for CMV-retinitis.Conclusions We recommend the following ophthalmological screening scheme for HIV-patients without ocular symptoms: (1) patients with a CD4+ count < 100 cells/mu l should be checked every third month and (2) those with a CD4+ count