Risk factors for cotton-wool spots and for cytomegalovirus retinitis in patients with human immunodeficiency virus infection.
OBJECTIVE
To investigate the risk factors for cotton-wool spots and for cytomegalovirus retinitis in patients with human immunodeficiency virus infection (HIV).


METHODS
A cross-sectional study was performed on 453 consecutive male patients with a positive serodiagnosis for HIV. The possible risk factors of age, race, absolute T-lymphocyte CD4+ count, and mode of HIV acquisition were evaluated.


RESULTS
Age and race were not significant predictors of either cotton-wool spots or cytomegalovirus retinitis. Low CD4+ T-lymphocyte counts were the strongest predictor of both types of retinopathy. After adjustment for CD4+ T-lymphocyte counts by logistic regression, patients who had acquired HIV through homosexual or bisexual activity were more likely to have cotton-wool spots (odds ratio, 2.09; P = 0.029) and cytomegalovirus retinitis (odds ratio, 4.14; P = 0.0028) than were patients who had acquired the disease intravenously.


CONCLUSIONS
The results of this study showed that the ocular manifestations of HIV infection are associated with low CD4+ counts and HIV acquisition through bisexual or homosexual activity. Patients with these risks factors should be targeted for prophylaxis and prevention strategies for cytomegalovirus retinitis.
Spaide
R F
RF
Department of Ophthalmology, St. Vincent's Hospital and Medical Center of New York, New York, USA.
Gaissinger
A
A
Podhorzer
J R
JR
D000328:Adult; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D003430:Cross-Sectional Studies; D017726:Cytomegalovirus Retinitis / Q000453:epidemiology / Q000209:etiology*; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006801:Humans; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D012044:Regression Analysis; D012164:Retinal Diseases / Q000453:epidemiology / Q000209:etiology; D012171:Retinal Vessels / Q000473:pathology*; D012307:Risk Factors; D012725:Sexual Behavior