title: Risk of cataract among subjects with acquired immune deficiency syndrome free of ocular opportunistic infections.
abstract: OBJECTIVE
  To evaluate the risk of cataract in the setting of AIDS.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Subjects with AIDS free of ocular opportunistic infections throughout catamnesis.
  
  
  METHODS
  From 1998 through 2008, subjects 13 years of age or older were enrolled. Demographic characteristics and clinical characteristics were documented at enrollment and semiannually.
  
  
  METHODS
  Cataract was defined as high-grade lens opacity observed by biomicroscopy judged to be the cause of a best-corrected visual acuity worse than 20/40. Eyes that underwent cataract surgery during follow-up were considered to have developed cataract before the first visit when pseudophakia or aphakia was observed.
  
  
  RESULTS
  Among 1606 participants (3212 eyes) at enrollment, 1.9% (95% confidence interval [CI]: 1.3%-2.7%) were observed to have cataract or prior cataract surgery. Among the 2812 eyes initially free of cataract and followed longitudinally (median follow-up, 4.6 years), the incidence of cataract was 0.37%/eye-year (95% CI: 0.26%-0.53%). In addition to age, significant cataract risk factors included prior cataract in the contralateral eye (adjusted hazard ratio [aHR], 21.6; 95% CI: 10.4-44.8), anterior segment inflammation (aHR, 4.40; 95% CI: 1.64-11.9), prior retinal detachment (aHR, 4.94; 95% CI: 2.21-11.0), and vitreous inflammation (aHR, 7.12; 95% CI: 2.02-25.0), each studied as a time-updated characteristic. Detectable human immunodeficiency virus RNA in peripheral blood was associated with lower risk of cataract at enrollment (adjusted odds ratio, 0.32; 95% CI: 0.12-0.80) but not of incident cataract (aHR, 1.58; 95% CI: 0.90-2.76). After adjustment for other factors, neither the then-current absolute CD4+ T-cell count nor antiretroviral therapy status showed consistent association with cataract risk, nor did an additive diagnosis of other comorbidities. Compared with the available population-based studies that used similar definitions of cataract, the age-specific prevalence of cataract in our cohort was higher than in 1 of 2 such studies, and the age-specific incidence of cataract surgery was higher.
  
  
  CONCLUSIONS
  Our results suggest cataract may occur earlier among patients with AIDS free of ocular opportunistic infections than in the general population. Cataract risk was associated most strongly with age and with other ocular morbidity in this population. With improved survival, the burden of cataract likely will increase for persons with the human immunodeficiency virus or AIDS.
authors.affiliation: Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania. Electronic address: john.kempen@uphs.upenn.edu.
authors.forename: John H
authors.initials: JH
authors.lastname: Kempen
authors.affiliation: Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sugar
authors.affiliation: Doheny Eye Institute, Department of Ophthalmology, University of Southern California, Los Angeles, California.
authors.forename: Rohit
authors.initials: R
authors.lastname: Varma
authors.affiliation: Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: James P
authors.initials: JP
authors.lastname: Dunn
authors.affiliation: Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Ophthalmology, Cornell University Medical College, New York, New York.
authors.forename: Murk-Hein
authors.initials: MH
authors.lastname: Heinemann
authors.affiliation: Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
authors.affiliation: Department of Ophthalmology, Northwestern University, Chicago, Illinois.
authors.forename: Alice T
authors.initials: AT
authors.lastname: Lyon
authors.affiliation: Department of Ophthalmology, Baylor College of Medicine, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Lewis
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000276:immunology / Q000821:virology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018791:CD4 Lymphocyte Count; D002386:Cataract / Q000453:epidemiology* / Q000821:virology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult
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