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REGARDLESS of the presence or absence of visual complaints, ischaemic macular changes may be present in HIV-infected patients with low CD4+ T-lymphocyte count, report Brazilian researchers. Zélia MS Corrêa MD began looking at patients who had very good vision despite their very low CD4+ counts after she learned of the discovery of ischaemic changes in patients infected with the human immunodeficiency virus. AIDS patients with CD4+ T-lymphocyte count under 50 are frequently subject to retinitis and choroiditis, along with other opportunistic infections and inflammation. Dr Corrêa presented a study of ischaemic macular changes in HIV positive patients with low CD4+ counts. She reported on the first nine patients enrolled in the study at the annual meeting of the Association for Research in Vision and Ophthalmology (ARVO). All of the patients had been referred from an AIDS clinic for consultation and had 20/30 vision or better. They were all males ranging in age between 30 and 66 years, with a median age of 38.3 years. Their CD4+ T-lymphocyte count varied from three to 45 cells per millilitre. All were receiving highly active anti-retroviral therapy (HAART). The study excluded pregnant women, patients with a history of systemic vascular disease, as well as those who were allergic to fluorescein. Study participants underwent ophthalmic evaluations which consisted of visual acuity examination, slit lamp biomicroscopy, tonometry and dilated fundus exam, followed by fluorescein angiography. "We found that 55% of them already had ischemic macular changes in one or both eyes, regardless of their visual symptoms, although the only patient with visual complaints did not present ischaemia. "That’s why we decided to look for any factors that would probably precede opportunistic infections. We wanted to know if there is any vascular alteration that could maybe tell us, ‘this is what is really predisposing the patient to develop opportunistic retinal infections’," Dr Corrèa told EuroTimes She now plans to look at patients with good vision but higher CD4+ counts - between 50 and 100 cells/ml - and see if there is a change there. A higher T-lymphocyte count should promote better circulation of the retina. It would be clinically very significant to establish that there is indeed a link between ischaemic macular changes and low CD4+ count in these patients before they develop opportunistic retinal infections. "Low CD4+ count could be a predictive factor but we are not sure. We are trying first to find the link between ischaemic macular alterations and the low CD4+ count. If we do find that this may be the first step in an opportunistic infection, then every patient with a low CD4+ count should have a fluorescein angiogram and if those alterations are found, then they should be watched very closely," Dr Corrêa said. Dr Corrêa also noted that the retinal problems of many of the patients are associated with neural problems. That could be a clue to what may be happening in their central nervous system, but she says that is "sheer speculation" at the moment. "Since the advent of HAART, the life of HIV patients has improved quite a bit. But we still see a lot of intraocular opportunistic infections on these patients. So I believe that in the context of HIV, it is very important again in preventing further problems and improving the quality of life of these patients who are bound to live many, many years. That did not happen before HAART therapy," Dr Corrêa said. "We are still trying to find clues which would indicate problems yet to come. Still in ophthalmology, we only treat when there is a problem. It would be nice if we could screen the HIV patients so that we would know who is bound to have those kinds of problems. "Certainly, similar to what is happening in oncology right now, where we are searching for the genes, we are searching for clues that will tell us this patient might have an important visual problem which could be a problem in his life and a handicap in the future," she explained. Dr Corrêa’s coauthors on the study were Luciano P Bellini MD, Diego Falci MD, André Freitas MD, Raquel Goldhardt MD and Italo M Marcon MD PhD. Zélia MS Corrêa MD PhD Ophthalmology Department - ISCMPA, Porto Alegre- RS, Brazil Email: zmcorrea@terra.com.br Zélia MS Corrêa MD PhD |
