Association between abnormal contrast sensitivity and mortality among people with acquired immunodeficiency syndrome.
OBJECTIVE
To investigate the relationship between contrast sensitivity (CS) and mortality among people with acquired immunodeficiency syndrome (AIDS); and to explore the hypothesis that abnormal CS is a marker of systemic, life-threatening microvascular disease.


METHODS
Longitudinal, observational cohort study.


METHODS
We evaluated 3395 eyes of 1706 individuals enrolled in the Longitudinal Study of the Complications of AIDS (1998-2008). CS was evaluated as a risk factor for death, and was compared to the presence of systemic diseases characterized by microvasculopathy (diabetes, cardiovascular disease, stroke, renal disease) and to laboratory markers of those diseases. Abnormal CS was defined as logCS <1.5 (lower 2.5th percentile for a normal control population).


RESULTS
CS was abnormal in 284 of 1691 (16.8%) study participants at enrollment. There was a positive relationship between the presence of abnormal CS at study entry and mortality (relative risk 2.0, 95% confidence interval 1.7-2.3, P < .0001). Abnormal CS was related to the presence of cardiovascular disease, stroke, and renal disease (all P values <or= .01), but abnormal CS remained associated with death even after adjustment for these diseases and for other known predictors of death among people with AIDS. Diseases characterized by microvasculopathy were more often identified as causes of death among individuals with abnormal CS than among those with normal CS, although the strength of the association was moderate (P = .06).


CONCLUSIONS
Abnormal CS among people with AIDS is associated with increased mortality, and is independent of other risk factors for death that are monitored routinely. The relationship may indicate life-threatening microvascular disease in other organs.
Holland
Gary N
GN
Ocular Inflammatory Disease Center, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7003, USA. uveitis@jsei.ucla.edu
Kappel
Peter J
PJ
Van Natta
Mark L
ML
Palella
Frank J
FJ
Lyon
Alice T
AT
Shah
Kayur H
KH
Pavan
Peter R
PR
Jabs
Douglas A
DA
D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality*; D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D015350:Contrast Sensitivity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010468:Perceptual Disorders / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors
Age Ageing. 1991 May;20(3):175-81
1853790
Bone. 2003 May;32(5):468-73
12753862
J Am Geriatr Soc. 1998 Jan;46(1):58-64
9434666
Optom Vis Sci. 2000 Aug;77(8):412-20
10966067
Diabet Med. 2008 Jan;25(1):45-50
18199131
Ann Intern Med. 1999 Mar 16;130(6):461-70
10075613
Arch Ophthalmol. 2006 Feb;124(2):243-9
16476894
Arch Ophthalmol. 1999 Nov;117(11):1487-95
10565517
Arch Ophthalmol. 1999 Jan;117(1):94-9
9930166
Am J Epidemiol. 2001 Oct 1;154(7):675-81
11581102
N Engl J Med. 1995 Mar 23;332(12):767-73
7862179
Am J Ophthalmol. 2008 Mar;145(3):453-462
18191094
Am J Ophthalmol. 2008 Mar;145(3):397-408
18282490
Ophthalmology. 2007 Apr;114(4):780-6
17258320
Arch Ophthalmol. 2001 Jun;119(6):881-7
11405840
Am Heart J. 1991 Jan;121(1 Pt 2):293-8
1985385
Invest Ophthalmol Vis Sci. 1994 Jun;35(7):3011-21
8206718
Trans Am Ophthalmol Soc. 2000;98:91-6; discussion 96-9
11190044
J Am Geriatr Soc. 2003 Mar;51(3):364-70
12588580
Diabetes Care. 2007 Feb;30(2):292-9
17259497
Invest Ophthalmol Vis Sci. 1993 Oct;34(11):3110-23
8407219
Diabetologia. 2008 Apr;51(4):583-8
18297258
Optom Vis Sci. 1994 Dec;71(12):750-60
7898882
J Am Geriatr Soc. 2006 Dec;54(12):1871-7
17198492
Med Clin (Barc). 2006 May 13;126(18):686-9
16759576
Lancet. 1996 Jul 20;348(9021):145-9
8684153
Diabetes Care. 2005 Jun;28(6):1383-9
15920056
Am J Ophthalmol. 2006 Aug;142(2):284-92
16876510
Invest Ophthalmol Vis Sci. 1997 Aug;38(9):1819-24
9286271
Ophthalmology. 1985 Apr;92(4):472-84
2987769
Ophthalmology. 2007 Apr;114(4):787-93
17210182
Br J Ophthalmol. 1996 Mar;80(3):209-13
8703857