简介:人类免疫缺陷病毒(HIV)感染和有治疗经验的患者的眼部受累是一个重要的问题,尽管抗逆转录病毒治疗(ART)药物的进步。HIV患者预期寿命的延长改变了HIV相关眼部疾病的范围,从轻微问题到严重视力障碍或失明。因此,了解这些并发症对于提供全面的医疗护理和改善生活质量至关重要.由于治疗方案的复杂性,接受多种ART的HIV患者可能会经历各种眼部疾病,药物毒性,免疫重建,和机会性感染。最值得考虑的是:巨细胞病毒(CMV)视网膜炎,免疫恢复葡萄膜炎(IRU),干燥性角膜结膜炎(干眼综合征),和HIV相关的神经视网膜疾病。材料和方法:对2013年1月1日至2023年12月31日的HIV/AIDS感染患者进行回顾性临床调查。该研究包括62名18岁以上的患者,谁通过酶联免疫吸附测定(ELISA)检测HIV阳性,并通过Westernblot(WB)确认,评估HIV血浆病毒载量(VL)和CD4+T细胞计数(CD4)。收集的数据包括人口统计,病理史,临床特征,验血,评估机会性感染,患者分期,开始抗逆转录病毒治疗,和疾病预后。结果:研究发现,大多数患者,37人年龄在30-39岁(59.7%),男性占59.7%,女性占40.3%。大多数人感染艾滋病毒10-19年(35.5%)。46.8%的患者初始CD4计数<200细胞/mm3,当研究完成时,这一比例提高到19.3%。尽管ART,CMV视网膜炎的患病率从最初的46.8%降至35.5%。其他情况包括眼弓形虫病(3.22%),结核相关性葡萄膜炎(1.6%),干燥性角膜结膜炎(19.3%),和HIV视网膜病变(29%)。值得注意的是,62.1%的CMV视网膜炎患者视力明显下降。口服伐更昔洛韦对影响多个部位的CMV疾病患者有益,对CMV视网膜炎的诱导和维持治疗均有效。结论:管理有HIV经验的患者的眼部并发症需要采用多学科方法并定期进行眼科评估,迅速治疗感染,和持续监测ART有效性。早期发现和干预对于保持视力和改善结果至关重要。该研究强调了即使在病毒抑制后也要持续监测的重要性。缩写:HIV=人类免疫缺陷病毒,ART=抗逆转录病毒疗法,CMV=巨细胞病毒,IRU=免疫恢复葡萄膜炎,ELISA=酶联免疫吸附测定,WB=西方印迹,VL=病毒载量,CD4=CD4+T细胞。
Introduction: Ocular involvement in human immunodeficiency virus (HIV) infected and treatment-experienced patients is a significant concern, despite the advancements in antiretroviral therapy (ART) medication. The extended life expectancy of HIV patients has altered the spectrum of HIV-associated ocular diseases, ranging from minor issues to severe vision impairment or blindness. Therefore, understanding these complications becomes crucial in providing comprehensive medical care and quality of life improvement. HIV patients on multiple ARTs can experience various ocular disorders due to the complexity of their treatment regimens, drug toxicities, immune reconstitution, and opportunistic infections. Most worthy to consider are: cytomegalovirus (CMV) retinitis, immune recovery uveitis (IRU), keratoconjunctivitis sicca (dry eye syndrome), and HIV-associated neuroretinal disorders. Materials and methods: A retrospective clinical investigation was conducted on HIV/AIDS-infected patients from January 1, 2013, to December 31, 2023. The study included 62 patients over 18 years, who tested HIV-positive via enzyme-linked immunosorbent assay (ELISA) and confirmed by Western blot (WB), with assessments of HIV plasma viral load (VL) and CD4+ T cell counts (CD4). Data collected included demographics, pathological histories, clinical characteristics, blood tests, assessments for opportunistic infections, patient staging, antiretroviral therapy initiation, and disease prognosis. Results: The study found that of most patients, 37 were aged 30-39 (59.7%), with 59.7% males and 40.3% females. Most had been living with HIV for 10-19 years (35.5%). Initial CD4 counts were < 200 cells/mm3 in 46.8% of patients, which improved to 19.3% when the study was done. CMV retinitis prevalence decreased from 46.8% initially to 35.5% despite ART. Other conditions included ocular toxoplasmosis (3.22%), tuberculosis-related uveitis (1,6%), keratoconjunctivitis sicca (19.3%), and HIV retinopathy (29%). Notably, 62.1% of CMV retinitis patients experienced significant visual acuity reduction. Oral valganciclovir was beneficial for patients with CMV disease affecting multiple sites and effective for both induction and maintenance therapy of CMV retinitis. Conclusions: Managing ocular complications in HIV-experienced patients requires a multidisciplinary approach with regular ophthalmologic evaluations, prompt treatment of infections, and continuous monitoring of ART effectiveness. Early detection and intervention are crucial for preserving vision and improving outcomes. The study highlighted the importance of constant monitoring even after viral suppression. Abbreviations: HIV = Human immunodeficiency virus, ART = antiretroviral therapy, CMV = cytomegalovirus, IRU = immune recovery uveitis, ELISA = enzyme-linked immunosorbent assay, WB = Western Blot, VL = viral load, CD4 = CD4+ T cells.