STUDY & TREATMENT OF RETINOPATHY ASSOCIATED WITH AIDS

艾滋病患者的视网膜病变包括非进行性视网膜病变。 视网膜病变表现为棉絮状斑块、出血和 微血管异常，以及进行性感染性 致盲的视网膜炎。我们计划研究这种病毒的发病机制和 非进行性视网膜病变的预后意义和 进展性感染的病原学和治疗反应 视网膜病变的前瞻性临床研究 仔细的视网膜检查和摄影结合新的 免疫诊断和放射成像技术。患有疾病的患者 视网膜病变将选自加州大学圣迭戈分校的艾滋病治疗方案 评估组。这些患者将包括同时患有两者的患者 各种形式的艾滋病相关视网膜病变。广泛的医疗和 实验室数据将通过与联合- 调查人员和顾问，将包括神经精神科 数据、中枢神经系统磁共振成像(MRI)、 猪瘟多器官病毒培养的免疫学状况及结果 人类免疫缺陷病毒(HIV)、单纯疱疹病毒(HSV)、 巨细胞病毒(CMV)和水痘带状疱疹病毒(VZV)。病人 患有非典型病毒性视网膜炎的患者将按顺序接受玻璃体生物显微镜检查 应用NEW确定视网膜病变的病因 开发了针对艾滋病病毒的快速免疫诊断技术 (HIV)、CMV、VZV和HSV。这些研究的结果将被用于 指导抗病毒化疗和新的免疫增强 治疗，对其反应也将进行评估。那些病人 发生与急性视网膜相关的视网膜脱离的人 坏死样综合征将接受脱离的修复 使用硅油，并将同时接受视网膜内 活检以评估视网膜炎的病因学性质 以及视网膜脱离的病理生理学。研究：关于 来自活组织检查和尸检样本的视网膜组织将 包括免疫病理学和艾滋病毒核酸杂交， HSV、CMV、VZV和EB病毒(EBV)，电子 显微镜和补体沉积研究。治疗 视网膜炎将包括更昔洛韦的抗病毒治疗。 由于巨细胞病毒和阿昔洛韦治疗带状疱疹或 水痘带状疱疹视网膜炎。更新的药物将按原样使用 发展起来的。β-干扰素的免疫增强治疗 和其他代理人也将接受评估。Ar的功效 激光在预防视网膜脱离中的应用 更昔洛韦治疗巨细胞病毒性视网膜炎将被研究。对.的使用 叠氮胸苷(AZT)与特异性抗病毒治疗视网膜炎 与艾滋病毒感染相关的研究将基于正在进行的研究 在加州大学圣迭戈分校艾滋病治疗评估组的支持下。 各种药物方案的疗效将在临床上进行评估。 通过病毒免疫学和培养数据，以及通过 检测玻璃体中的药物浓度 接受玻璃体活检。

The retinal lesions seen in AIDS patients include a non-progressive retinopathy manifested by cotton-wool patches, hemorrhages, and microvascular abnormalities, as well as a progressive infectious blinding retinitis. We plan to investigate the pathogenesis and prognostic implications of the non-progressive retinopathy and the etiology and response to treatment of the progressive infectious retinopathy by performing a prospective clinical study utilizing careful retinal examination and photography combined with new immuno-diagnostic and radiographic techniques. Patients with retinopathy will be selected from the UCSD AIDS Treatment Evaluation Unit. These patients will include those with both forms of AIDS associated retinopathy. Extensive medical and laboratory data will be provided through collaboration with co- investigators and consultants and will include neuropsychiatric data, central nervous system magnetic resonance imaging (MRI), immunologic status and results of multi-organ viral cultures for Human Immunodeficiency Virus (HIV), herpes simplex virus (HSV), cytomegalovirus (CMV), and varicella zoster virus (VZV). Patients with atypical viral retinitis will undergo vitreous biospy in order to determine the etiologic agent of the retinitis using newly developed rapid immunodiagnostic techiques for the AIDS virus (HIV), CMV, VZV, and HSV. Results of these studies will be used to guide antiviral chemotherapy and new immunoaugmentation therapies, response to which will also be assessed. Those patients who develop retinal detachment associated with an acute retinal necrosis-like syndrome will undergo repair of the detachment using silicone oil and will simultaneously undergo endoretinal biopsy in order to evaluate the etiologic nature of the retinitis and the pathophysiology of the retinal detachment. Studies on retinal tissue from biopsies and from autopsy specimens will include immunopathology and nucleic acid hybridization for HIV, HSV, CMV, VZV and Epstein-Barr (EBV) viruses, electron microscopy and complement deposition studies. Treatment of retinitis will include antiviral therapy with ganciclovir for that due to cytomegalovirus and with acyclovir for herpes zoster or varicella zoster retinitis. Newer drugs will be used as they are developed. Immunoaugmentation therapy with Beta interferon and other agents will also be evaluated. The efficacy of argon laser for prophylaxis of retinal detachment associated with ganciclovir treatment of CMV retinitis will be studied. The use of azidothymidine (AZT) and specific antiviral therapy for retinitis associated with HIV infection will be based on ongoing studies under the aegis of the AIDS Treatment Evaluation Unit at UCSD. The efficacy of various drug regimens will be assessed clinically and through viral immunologic and culture data, as well as by determining drug levels in the vitreous of those patients who undergo vitreous biopsy.