Studies of Ocular Complications of AIDS - Chairman's Office

描述（由申请人提供）：艾滋病眼部并发症研究小组致力于了解和改善艾滋病眼部并发症的结果。艾滋病眼部并发症的纵向研究（LSOCA）是一项前瞻性队列研究，研究这些并发症及其在高效抗逆转录病毒治疗（HAART）时代的结局，目前已进入第九年的随访期。与大多数HIV感染患者的队列研究不同，LSOCA从选定的风险群体中招募艾滋病患者。截至2006年12月31日，LSOCA队列招募了2024例患者，其中448例患有巨细胞病毒视网膜炎，18例患有其他眼部机会性感染（Ols）。尽管HAART降低了AIDS患者眼部Ols的发病率，但新病例仍在继续发生，并且越来越多的AIDS和眼部Ols患者经历了免疫恢复。虽然已经描述了短期结果，但没有长期数据，这些患者对HAART反应的持久性也是未知的。长期数据对于评估资源需求和确定管理准则至关重要。在没有眼部OIs的AIDS患者中也存在视觉系统异常，表现为对比敏感度降低，其程度常常足以损害阅读速度，以及表现为视野丧失。关于这种神经视网膜疾病的发病机制、危险因素和病程，特别是其长期后果知之甚少。此外，在没有眼部OIs的AIDS患者中，白内障的患病率似乎增加，这可能会因HAART的代谢副作用而加重，如糖尿病和高脂血症。宿主遗传因素对HIV感染的病程有很大影响，但其对眼部并发症的发生率和病程的影响尚不清楚。眼部并发症的免疫机制也需要更好地阐明。LSOCA队列将满足这些领域对长期数据的持续需求。本提案的具体目的是评估艾滋病患者的以下方面：1）眼部Ols的长期结局; 2）无眼部Ols患者的视力损害; 3）眼部并发症的宿主遗传风险因素和免疫机制及其结局。

DESCRIPTION (provided by applicant): The Studies of the Ocular Complications of AIDS Research Group is dedicated to understanding and improving the outcomes of the ocular complications of AIDS. The Longitudinal Study of the Ocular Complications of AIDS (LSOCA) is a prospective cohort study of these complications and their outcomes in the era of highly active antiretroviral therapy (HAART), and is currently in its ninth year of follow-up. Unlike most cohort studies of HIV-infected patients, which enroll from selected risk groups, LSOCA enrolls patients with AIDS from all risk groups. As of 31 December 2006 the LSOCA cohort has recruited 2024 patients, of whom 448 have cytomegalovirus retinitis and 18 have other ocular opportunistic infections (Ols). Although HAART has decreased the incidence of ocular Ols among patients with AIDS, new cases continue to occur, and there is an increasingly large number of patients with AIDS and ocular Ols who have experienced immune recovery. Although short-term outcomes have been described, no long-term data are available, and the durability of the response to HAART among these patients is unknown. Long-term data are critical for assessing resource needs and determining management guidelines. There also are abnormalities of the visual system among patients with AIDS without ocular Ols, manifested as decreased contrast sensitivity, often of sufficient magnitude to impair reading speed, and as visual field loss. Little is known about the pathogenesis of, the risk factors for, and the course of this neuroretinal disorder, particularly its long-term consequences. In addition, there appears to be an increased prevalence of cataract among patients with AIDS without ocular Ols, which may be aggravated by the metabolic side effects of HAART, such as diabetes and hyperlipidemia. Host genetic factors have a substantial effect on the course of HIV infection, but their effect on the incidence and course of ocular complications is unknown. The immunologic mechanisms underlying ocular complications also need to be elucidated better. The LSOCA cohort will address the ongoing need for long-term data in these areas. The specific aims of this proposal are to evaluate the following among patients with AIDS: 1) the long-term outcomes of ocular Ols; 2) visual impairment among patients without ocular Ols; and 3) host genetic risk factors for and immunologic mechanisms of ocular complications and their outcomes.