Vision function in HIV-infected individuals without retinitis: report of the Studies of Ocular Complications of AIDS Research Group.
OBJECTIVE
To evaluate the prevalence and risk factors for vision loss in patients with clinical or immunologic AIDS without infectious retinitis.


METHODS
A prospective, multicenter cohort study of patients with AIDS.


METHODS
One thousand three hundred and fifty-one patients (2,671 eyes) at 19 clinical trials centers diagnosed with AIDS but without major ocular complications of HIV. Standardized measurements of visual acuity, automated perimetry, and contrast sensitivity were analyzed and correlated with measurements of patients' health and medical data relating to HIV infection. We evaluated correlations between vision function testing and HIV-related risk factors and medical testing.


RESULTS
There were significant (P<.05) associations between measures of decreasing vision function and indices of increasing disease severity, including Karnofsky score and hemoglobin. A significant relationship was seen between low-contrast sensitivity and decreasing levels of CD4+ T-cell count. Three percent of eyes had a visual acuity worse than 20/40 Snellen equivalents, which was significantly associated with a history of opportunistic infections and low Karnofsky score. When compared with external groups with normal vision, 39% of eyes had abnormal mean deviation on automated perimetry, 33% had abnormal pattern standard deviation, and 12% of eyes had low contrast sensitivity.


CONCLUSIONS
This study confirms that visual dysfunction is common in patients with AIDS but without retinitis. The most prevalent visual dysfunction is loss of visual field; nearly 40% of patients have some abnormal visual field. There is an association between general disease severity and less access to care and vision loss. The pathophysiology of this vision loss is unknown but is consistent with retinovascular disease or optic nerve disease.
Freeman
William R
WR
Joan and Irwin Jacobs Retina Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California 92037, USA. freeman@eyecenter.ucsd.edu
Van Natta
Mark L
ML
Jabs
Douglas
D
Sample
Pamela A
PA
Sadun
Alfredo A
AA
Thorne
Jennifer
J
Shah
Kayur H
KH
Holland
Gary N
GN
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D015350:Contrast Sensitivity / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D014786:Vision Disorders / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D014792:Visual Acuity / Q000502:physiology*; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology*