title: Neuroretinal Degeneration in HIV Patients Without Opportunistic Ocular Infections in the cART Era.
abstract: Subtle structural and functional retinal abnormalities, termed 'HIV-associated Neuroretinal Disorder (HIV-NRD)', have been reported in HIV patients receiving combination antiretroviral therapy (cART), without infectious retinitis or any apparent fundus abnormalities otherwise. In this review, we provide an overview of studies investigating HIV-NRD in HIV patients without opportunistic ocular infections in the cART era, and try to elucidate underlying mechanisms and associated risk factors. Most studies focused on patients with severe immune-deficiency and demonstrated that patients with nadir CD4 counts<100 cells/μL are most at risk for neuroretinal damage, with a thinner retinal nerve fiber layer, subtle loss of color vision and/or contrast sensitivity, visual field deficits, and subnormal electrophysiological responses. In contrast, alterations in retinal vascular calibers and retinal blood flow were not associated with nadir CD4 counts, but instead with detectable viremia, suggesting a role for (chronic) inflammation in microvascular damage. Although the alterations in visual function are subtle, they can lead to difficulties in activities, such as reading or driving, thereby affecting quality of life. Since HIV has become a chronic disease, its long-term effects with respect to visual function loss become more important, as is recently emphasized by a longitudinal study, reporting that AIDS patients with HIV-NRD have higher risks of developing bilateral visual impairment and even blindness than patients without HIV-NRD. The question remains whether patients with high (>350 cells/μL) nadir CD4 counts and well-suppressed HIV infection on cART remain at risk for HIV-NRD, as this group constitutes a growing part of the aging HIV-infected population.
authors.affiliation: 1 Department of Ophthalmology, Academic Medical Center , Amsterdam, The Netherlands .
authors.forename: Nazli
authors.initials: N
authors.lastname: Demirkaya
authors.affiliation: 2 Departments of Global Health and Amsterdam Institute for Global Health and Development , Amsterdam, The Netherlands .|3 Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Center , Amsterdam, The Netherlands .
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Wit
authors.affiliation: 1 Department of Ophthalmology, Academic Medical Center , Amsterdam, The Netherlands .|4 Netherlands Institute for Neuroscience (NIN), Royal Academy of Sciences (KNAW) , Amsterdam, The Netherlands .
authors.forename: Reinier
authors.initials: R
authors.lastname: Schlingemann
authors.affiliation: 1 Department of Ophthalmology, Academic Medical Center , Amsterdam, The Netherlands .|5 Department of Biomedical Engineering and Physics, Academic Medical Center , Amsterdam, The Netherlands .
authors.forename: Franciscus
authors.initials: F
authors.lastname: Verbraak
mesh_terms: D018791:CD4 Lymphocyte Count; D015350:Contrast Sensitivity / Q000502:physiology; D015828:Eye Infections, Viral / Q000503:physiopathology*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000503:physiopathology*; D011788:Quality of Life; D012164:Retinal Diseases / Q000503:physiopathology*; D012307:Risk Factors; D019562:Viral Load; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology