Visual functions in patients with cytomegalovirus uveitis and HIV infection

Abstract

BACKGROUND: Cytomegalovirus damage to the eye is the leading cause of loss of visual functions associated with HIV. Effective treatment of HIV-infected patients has changed the understanding of the clinical picture of cytomegalovirus uveitis (CMV-uveitis).

AIM: The aim of the work is to determine the prevalence, the structure of clinical forms and to evaluate visual functions in HIV-infected patients with CMV-uveitis.

MATERIALS AND METHODS: The study group consisted of 66 HIV-infected patients with CMV-uveitis (97 eyes), of which there were 27 men (40.9%), 39 women (59.1%). The average age was 39.6 ± 3.91 years. All patients had stage 4B of HIV infection according to V.V. Pokrovsky’s classification (2006). During the work, visometry, perimetry, biomicroscopy, ophthalmoscopy were used.

RESULTS: The main form of the disease is chorioretinitis, diffuse and generalized forms of the disease are diagnosed in 68.0% of cases. In predicting visual acuity, the leading regression criterion was the clinical form of the disease.

CONCLUSIONS: Diffuse and generalized forms of the disease prevailed in clinical practice. Localization of the chorioretinal process of a predominantly diffuse nature predetermined visual acuity, which in more than a third of cases met the criteria for blindness according to the WHO classification (1977).

Keywords

cytomegalovirus uveitis / human immunodeficiency virus (HIV) / HIV-infection / opportunistic disease

References

[1] Kestelyn PG, Cunningham ET. HIV/AIDS and blindness. Bulletin of the World Health Organisation. 2001;79(3):208–213.

[2] Kestelyn P.G., Cunningham E.T. HIV/AIDS and blindness // Bulletin of the World Health Organisation. 2001. Vol. 79, No. 3. P. 208–213.

[3] Holbrook JT, Jabs DA, Weinberg DV, et al. Visual loss in patients with cytomegalovirus retinitis and acquired immunodeficiency syndrome before widespread availability of highly active antiretroviral therapy. Arch Ophthalmol. 2003;121:99–107. DOI: 10.1001/archopht.121.1.99

[4] Holbrook J.T., Jabs D.A., Weinberg D.V., et al. Visual loss in patients with cytomegalovirus retinitis and acquired immunodeficiency syndrome before widespread availability of highly active antiretroviral therapy // Arch Ophthalmol. 2003. Vol. 121. P. 99–107. DOI: 10.1001/archopht.121.1.99

[5] Onishchenho AL, Kolbasko AV, Tatarnikova GN, Chernysheva AD. Retinal detachment in HIV-infected patients with cytomegalovirus retinitis. The Russian Annals of Ophthalmology. 2014;130(3):42–44. (In Russ.)

[6] Онищенко А.Л., Колбаско А.В., Татарникова Г.Н., Чернышева А.Д. Отслойка сетчатки у ВИЧ-инфицированных пациентов с цитомегаловирусным ретинитом // Вестник офтальмологии. 2014. Т. 130, № 3. C. 42–44.

[7] Pantelleva OV, Bembeeva NA, Volkova TM, et al. (Saint Petersburg Center for the Prevention and Control of AIDS and Infectious Diseases, Saint Petersburg, Russia). Newsletter “HIV infection in Saint Petersburg as of January 01, 2021”. Saint Petersburg (Russia), 2021 [cited 2022 Aug 28]. Available at: https://www.hiv-spb.ru/lsn/informaczionnyie-byulleteni.html. (In Russ.)

[8] Пантелеева О.В., Бембеева Н.А., Волкова Т.М. и др. (СПб ГБУЗ Центр по профилактике и борьбе со СПИД и инфекционными заболеваниями, Санкт-Петербург, Россия). Информационный бюллетень «ВИЧ-инфекция в Санкт-Петербурге по состоянию на 01.01.2021». Санкт-Петербург (Россия), 2021. Режим доступа: https://www.hiv-spb.ru/lsn/informaczionnyie-byulleteni.html. Дата обращения: 28.08.2022.

[9] Kempen JH, Sugar EA, Lyon AT, et al. Studies of Ocular Complications of AIDS Research Group. Risk of cataract in persons with cytomegalovirus retinitis and the acquired immune deficiency syndrome. Ophthalmology. 2012;119(11):2343–2350. DOI: 10.1016/j.ophtha.2012.05.044

[10] Kempen J.H., Sugar E.A., Lyon A.T., et al. Studies of Ocular Complications of AIDS Research Group. Risk of cataract in persons with cytomegalovirus retinitis and the acquired immune deficiency syndrome // Ophthalmology. 2012. Vol. 119, No. 11. P. 2343–2350. DOI: 10.1016/j.ophtha.2012.05.044

[11] Cassoux N, Lumbroso L, Bodaghi B, et al. Cystoid macular oedema and cytomegalovirus retinitis in patients with HIV disease treated with highly active antiretroviral therapy. Br J Ophthalmol. 1999;83(1):47–49. DOI: 10.1136/bjo.83.1.47

[12] Cassoux N., Lumbroso L., Bodaghi B., et al. Cystoid macular oedema and cytomegalovirus retinitis in patients with HIV disease treated with highly active antiretroviral therapy // Br J Ophthalmol. 1999. Vol. 83, No. 1. C. 47–49. DOI: 10.1136/bjo.83.1.47

[13] Hizhnyak TV, Astahov YuS, Rahmanova AG. K voprosu o rannei diagnostike TsMV-retinita u bol’nykh VICh-infektsiei. Ophthalmology Journal. 2011;4(2):39–45. (In Russ.)

[14] Хижняк Т.В., Астахов Ю.С., Рахманова А.Г. К вопросу о ранней диагностике ЦМВ-ретинита у больных ВИЧ-инфекцией // Офтальмологические ведомости. 2011. Т. 4, № 2. С. 39–45.

[15] Onischenko AL, Kolbasko AV, Tatarnikova GN, Chernysheva AD. Treatment of retinal separation in HIV-infected patients with cytomegalovirus retinitis. Ophthalmology in Russia. 2017;14(1):84–87. (In Russ.) DOI: 10.18008/1816-5095-2017-1-84-87

[16] Онищенко А.Л., Колбаско А.В., Татарникова Г.Н., Чернышева А.Д. Лечение отслойки сетчатки у ВИЧ-инфицированных пациентов с цитомегаловирусным ретинитом // Офтальмология. 2017. Т. 14, № 1. С. 84–87. DOI: 10.18008/1816-5095-2017-1-84-87

[17] Gavrilova TV, Sergienko AP, Chereshneva MV, Sobianina AN. Eye damage at the terminal stage of HIV infection. Clinical case. Ophthalmology in Russia. 2021;18(2):368–373. (In Russ.) DOI: 10.18008/1816-5095-2021-2-368-373

[18] Гаврилова Т.В., Сергиенко А.П., Черешнева М.В., Собянина А.Н. Поражение органа зрения при терминальной стадии ВИЧ-инфекции. Клинический случай // Офтальмология. 2021. Т. 18, № 2. С. 368–373. DOI: 10.18008/1816-5095-2021-2-368-373

[19] Sizova TD, Khokkanen VM, Gusev DA, Boiko EV. Cytomegalovirus uveitis in HIV-infected patients: course and outcomes. Journal Infectology. 2020;12(4):45–50. (In Russ.) DOI: 10.22625/2072-6732-2020-12-4-45-50

[20] Сизова Т.Д., Хокканен В.М., Гусев Д.А., Бойко Э.В. Цитомегаловирусный увеит у ВИЧ-инфицированных пациентов: течение и исходы // Журнал инфектологии. 2020. Т. 12, № 4. С. 45–50. DOI: 10.22625/2072-6732-2020-12-4-45-50

[21] Ando Y, Terao K, Narita M, et al. Quantitative analyses of cytomegalovirus genome in aqueous humor of patients with cytomegalovirus retinitis. Jpn J Ophthalmol. 2002;46(3):254–260. DOI: 10.1016/s0021-5155(01)00524-x

[22] Ando Y., Terao K., Narita M., et al. Quantitative analyses of cytomegalovirus genome in aqueous humor of patients with cytomegalovirus retinitis // Jpn J Ophthalmol. 2002. Vol. 46, No. 3. P. 254–260. DOI: 10.1016/s0021-5155(01)00524-x

[23] Chen C, Guo CG, Meng L, et al. Comparative analysis of cytomegalovirus retinitis and microvascular retinopathy in patients with acquired immunodeficiency syndrome. Int J Ophthalmol. 2017;10(9):1396–1401. DOI: 10.18240/ijo.2017.09.11

[24] Chen C., Guo C.G, Meng L., et al. Comparative analysis of cytomegalovirus retinitis and microvascular retinopathy in patients with acquired immunodeficiency syndrome // Int J Ophthalmol. 2017. Vol. 10, No. 9. P. 1396–1401. DOI: 10.18240/ijo.2017.09.11

[25] Tang S, Zhao N, Wang LY, Wen Y. Frosted branch angiitis due to cytomegalovirus-associated unmasking immune reconstitution inflammatory syndrome: a case report and literature review. BMC Infectious Diseases. 2021;21(1):613. DOI: 10.1186/s12879-021-06311-4

[26] Tang S., Zhao N., Wang L.Y., Wen Y. Frosted branch angiitis due to cytomegalovirus-associated unmasking immune reconstitution inflammatory syndrome: a case report and literature review // BMC Infectious Diseases. 2021. Vol. 21, No. 1. P. 613. DOI: 10.1186/s12879-021-06311-4

[27] Li W, Wang X, Zhao L, et al. The value and implementation of routine ophthalmic examination in the era of HAART. EClinicalMedicine. 2020;31:100646. DOI: 10.1016/j.eclinm.2020.100646

[28] Li W., Wang X., Zhao L., et al. The value and implementation of routine ophthalmic examination in the era of HAART // EClinicalMedicine. 2020. Vol. 31. P. 100646. DOI: 10.1016/j.eclinm.2020.100646

[29] Heiden D, Tun N, Smithuis FN, et al. Active cytomegalovirus retinitis after the start of antiretroviral therapy. Br J Ophthalmol. 2019;103(2):157–160. DOI: 10.1136/bjophthalmol-2018-312406

[30] Heiden D., Tun N., Smithuis F.N., et al. Active cytomegalovirus retinitis after the start of antiretroviral therapy // Br J Ophthalmol. 2019. Vol. 103, No. 2. P. 157–160. DOI: 10.1136/bjophthalmol-2018-312406

[31] Sugar EA, Jabs DA, Ahuja A, et al. Incidence of cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Am J Ophthalmol. 2012;153(6):1016–1024. DOI: 10.1016/j.ajo.2011.11.014

[32] Sugar E.A., Jabs D.A., Ahuja A., et al. Incidence of cytomegalovirus retinitis in the era of highly active antiretroviral therapy // Am J Ophthalmol. 2012. Vol. 153, No. 6. P. 1016–1024. DOI: 10.1016/j.ajo.2011.11.014

[33] Chakraborty A, Mahapatra T, Mahapatra S, et al. Distribution and determinants of cytomegalovirus induced end organ disease/s among people living with HIV/AIDS in a poor resource setting: observation from India. PLoS One. 2015;10(2): e0117466. DOI: 10.1371/journal.pone.0117466

[34] Chakraborty A., Mahapatra T., Mahapatra S., et al. Distribution and determinants of cytomegalovirus induced end organ disease/s among people living with HIV/AIDS in a poor resource setting: observation from India // PLoS One. 2015. Vol. 10, No. 2. P. e0117466. DOI: 10.1371/journal.pone.0117466

[35] Maksimov VJu, Dmitrieva OG, Evseev SJu, Aleksandrova NM. Diagnosis and treatment of uveitis of herpesvirus and chlamydia etiology. Russian Journal of Clinical Ophthalmology. 2003;4(4):168. (In Russ.)

[36] Максимов В.Ю., Дмитриева О.Г., Евсеев С.Ю., Александрова Н.М. Диагностика и лечение увеитов герпесвирусной и хламидийной этиологии // Российский Медицинский Журнал. Клиническая офтальмология. 2003. Т. 4, № 4. С. 168.

[37] Kacnel’son LA, Tankovskij VJe. Uveitis (clinic, treatment). Moscow: 4-y filial Voenizdata; 2003. (In Russ.)

[38] Кацнельсон Л.А., Танковский В.Э. Увеиты (клиника, лечение). Москва: 4-й филиал Воениздата, 2003.

[39] Jabs DA, Nussenblatt RB, Rosenbaum JT.; Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005;140(3):509–516. DOI: 10.1016/j.ajo.2005.03.057

[40] Jabs D.A., Nussenblatt R.B., Rosenbaum J.T.; Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop // Am J Ophthalmol. 2005. Vol. 140, No. 3. P. 509–516. DOI: 10.1016/j.ajo.2005.03.057

[41] Federal clinical guidelines “Non-infectious uveitis in adults, 2019” [cited 2022 Sept 07]. Avaible at: https://oor.ru/files/uveity/uveity.pdf (In Russ.)

[42] Федеральные клинические рекомендации «Неинфекционные увеиты у взрослых, 2019» Режим доступа: https://oor.ru/files/uveity/uveity.pdf Дата обращения: 07.09.2022.

RIGHTS & PERMISSIONS

Sizova T.D., Khokkanen V.M., Zumbulidze N.G., Boiko E.V.