Risk of Cataract among Subjects with Acquired Immune Deficiency Syndrome Free of Ocular Opportunistic Infections
Risk of Cataract among Subjects with Acquired Immune Deficiency Syndrome Free of Ocular Opportunistic Infections
复制标题
DOI：
10.1016/j.ophtha.2014.06.014
复制
发表时间：
2014-12-01
期刊：
影响因子：
13.7
通讯作者：
Lewis, Richard A.
中科院分区：
文献类型：
--
作者：
Kempen, John H.;Sugar, Elizabeth A.;Lewis, Richard A.
目的：评估艾滋病背景下白内障的风险。设计：前瞻性队列研究。参与者：在整个康复过程中没有眼部机会性感染的艾滋病受试者。方法：从 1998 年到 2008 年，招募了 13 岁或以上的受试者。在入组时和每半年记录人口统计特征和临床特征。 主要结果指标：白内障定义为通过生物显微镜观察到的高度晶状体混浊，被判断为最佳矫正视力低于20/40的原因。当观察到人工晶状体或无晶状体眼时，在随访期间接受过白内障手术的眼睛被认为在首次就诊之前已经出现了白内障。 结果：在入组时的 1606 名参与者（3212 只眼睛）中，观察到 1.9%（95% 置信区间 [CI]：1.3%-2.7%）患有白内障或既往接受过白内障手术。在最初没有白内障并进行纵向随访（中位随访 4.6 年）的 2812 只眼睛中，白内障发病率为 0.37%/眼年（95% CI：0.26%-0.53%）。除年龄外，显着的白内障危险因素包括对侧眼既往白内障（调整后风险比[aHR]，21.6；95% CI：10.4-44.8）、眼前节炎症（aHR，4.40；95% CI：1.64-11.9）、既往视网膜脱离（aHR，4.94；95% CI： 2.21-11.0）和玻璃体炎症（aHR，7.12；95% CI：2.02-25.0），每个都作为时间更新的特征进行研究。外周血中可检测到的人类免疫缺陷病毒RNA与入组时较低的白内障风险相关（调整后的比值比，0.32；95% CI：0.12-0.80），但与白内障发病风险无关（aHR，1.58；95% CI：0.90-2.76）。调整其他因素后，当时的绝对 CD4+ T 细胞计数和抗逆转录病毒治疗状态均未显示出与白内障风险的一致相关性，其他合并症的附加诊断也未显示出与白内障风险的一致相关性。与现有的使用类似白内障定义的基于人群的研究相比，我们队列中白内障的特定年龄患病率高于 2 项此类研究中的 1 项，并且白内障手术的特定年龄发生率更高。结论：我们的结果表明，无眼部机会性感染的艾滋病患者白内障可能比一般人群更早发生。在该人群中，白内障风险与年龄和其他眼部疾病的相关性最强。随着生存率的提高，人类免疫缺陷病毒或艾滋病患者的白内障负担可能会增加。 (C) 2014 年由美国眼科学会颁发。
Purpose: To evaluate the risk of cataract in the setting of AIDS.Design: Prospective cohort study.Participants: Subjects with AIDS free of ocular opportunistic infections throughout catamnesis.Methods: From 1998 through 2008, subjects 13 years of age or older were enrolled. Demographic characteristics and clinical characteristics were documented at enrollment and semiannually.Main Outcome Measures: Cataract was defined as high-grade lens opacity observed by biomicroscopy judged to be the cause of a best-corrected visual acuity worse than 20/40. Eyes that underwent cataract surgery during follow-up were considered to have developed cataract before the first visit when pseudophakia or aphakia was observed.Results: Among 1606 participants (3212 eyes) at enrollment, 1.9% (95% confidence interval [CI]: 1.3%-2.7%) were observed to have cataract or prior cataract surgery. Among the 2812 eyes initially free of cataract and followed longitudinally (median follow-up, 4.6 years), the incidence of cataract was 0.37%/eye-year (95% CI: 0.26%-0.53%). In addition to age, significant cataract risk factors included prior cataract in the contralateral eye (adjusted hazard ratio [aHR], 21.6; 95% CI: 10.4-44.8), anterior segment inflammation (aHR, 4.40; 95% CI: 1.64-11.9), prior retinal detachment (aHR, 4.94; 95% CI: 2.21-11.0), and vitreous inflammation (aHR, 7.12; 95% CI: 2.02-25.0), each studied as a time-updated characteristic. Detectable human immunodeficiency virus RNA in peripheral blood was associated with lower risk of cataract at enrollment (adjusted odds ratio, 0.32; 95% CI: 0.12-0.80) but not of incident cataract (aHR, 1.58; 95% CI: 0.90-2.76). After adjustment for other factors, neither the then-current absolute CD4+ T-cell count nor antiretroviral therapy status showed consistent association with cataract risk, nor did an additive diagnosis of other comorbidities. Compared with the available population-based studies that used similar definitions of cataract, the age-specific prevalence of cataract in our cohort was higher than in 1 of 2 such studies, and the age-specific incidence of cataract surgery was higher.Conclusions: Our results suggest cataract may occur earlier among patients with AIDS free of ocular opportunistic infections than in the general population. Cataract risk was associated most strongly with age and with other ocular morbidity in this population. With improved survival, the burden of cataract likely will increase for persons with the human immunodeficiency virus or AIDS. (C) 2014 by the American Academy of Ophthalmology.