Diagnosis And Treatment Of Aids-related Ocular Disease

该项目的目标是开发诊断和治疗获得性免疫缺陷综合征（艾滋病）眼部并发症的改进方法。该项目包括评估艾滋病相关眼病患者新的诊断和治疗方法的临床试验，以及巨细胞病毒（CMV）视网膜炎患者的自然史研究。巨细胞病毒（CMV）视网膜炎是艾滋病患者最常见的眼内感染，往往发生在CD4+细胞计数下降到每微升低于50个细胞后。尽管用更昔洛韦、膦甲酸钠或西多福韦进行抗CMV治疗最初导致视网膜炎失活，但由于对复制病毒的控制不足，尽管继续治疗，但几乎所有患者的疾病都会进展。最近的病例报告表明，使用通常由蛋白酶抑制剂和核苷类似物组成的高效抗逆转录病毒疗法治疗，已导致人类免疫缺陷病毒（HIV）载量降低和CD4+计数增加。NEI一直在进行一项前瞻性临床试验，以确定是否可以在稳定的CMV视网膜炎患者中安全地停用维持性抗CMV药物。该研究还旨在确定停止抗CMV治疗是否会增加HIV载量或引起眼内炎症。试验初期阶段的征聘工作已经完成。迄今为止，没有患者发生CMV进展或任何其他研究终点，这些结果已发表。出乎意料的是，该试验中的大多数患者被观察到患有与其免疫恢复相关的眼部炎症，这种现象称为免疫恢复葡萄膜炎。最近发表了在参与本试验的患者中观察到的这种综合征的详细信息。该方案将继续研究高效抗逆转录病毒治疗在维持CD4+计数增加和非活动性CMV视网膜炎方面的持久性。

The goal of this project is to develop improved methods for diagnosing and treating the ocular complications of the acquired immunodeficiency syndrome (AIDS). This project encompasses clinical trials evaluating new diagnostic and therapeutic approaches for patients with AIDS-related eye disorders, as well as natural history studies of patients with Cytomegalovirus (CMV) retinitis. Cytomegalovirus (CMV) retinitis is the most common intraocular infection in patients with AIDS and tends to occur after CD4+ cell counts decrease to less than 50 cells per microliter. Although anti-CMV therapy with ganciclovir, foscarnet sodium, or cidofovir initially leads to inactivation of the retinitis, the disease progresses in almost all patients despite continued therapy because of inadequate control of the replicating virus. Recent case reports have shown that treatment with highly active antiretroviral therapy, commonly consisting of protease inhibitors and nucleoside analogs, has led to decreased human immunodeficiency virus (HIV) loads and increased CD4+ counts. The NEI has been conducting a prospective clinical trial to determine whether maintenance anti-CMV medications can be safely discontinued in patients with stable CMV retinitis. The study was also designed to determine whether discontinuing anti-CMV therapy will increase HIV load or cause intraocular inflammation. Recruitment of the initial phase of the trial has been completed. To date, no patient has experienced CMV progression or any other study endpoint and these results were published. Unexpectedly, the majority of the patients in this trial were observed to have ocular inflammation related to their immune recovery, a phenomenon termed immune recovery uveitis. The details of this syndrome observed in patients participating in this trial were recently published. The protocol will continue to examine the durability of highly active antiretroviral therapy in maintaining increased CD4+ counts and inactive CMV retinitis.