OCULAR MANIFESTATIONS IN PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION BEFORE AND AFTER THE INTRODUCTION OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY
Autori:
Branko Mesarić, Miroslav Lisić, Tihana Kniewald, Nikola Ugrinović, Josip Begovac
Sažetak
Sažetak. Cilj rada bio je utvrditi i usporediti učestalost različitih očnih promjena u bolesnika zaraženih virusom humane imunodeficijencije (HIV) prije ere vrlo djelotvomog antiretrovirusnog liječenja (HAART od engl. highly active antiretroviral treatment) te nakon njegove primjene u bolesnika liječenih u Klinici za infektivne bolesti »Dr. Fran Mihaljević« u Zagrebu. U retrospektivnu longitudinalnu analizu uključeni su odrasli bolesnici s potvrđenom infekcijom HIV-l koji su podijeljeni u dvije skupine: razdoblje prije HAART-a (1995-1997. g.) i razdoblje HAART-a (1998-2000. g.). Ukljućeni su samo oni bolesnici koji su imali barem dva oftalmološka pregleda u bilo kojem ili u oba navedena razdoblja. U istraživanje je ukupno uključeno 85 bolesnika: u razdoblju 1995-1997. g. bilo je 50 bolesnika, a u razdoblju 1998-2000. g. 47 bolesnika (12 bolesnika praćeno je u oba razdoblja). Smrtnost je bila zr1ačajno manja u bolesnika liječenih u eri HAART-a, prosječno smanjenje smrtnosti izr1osilo je 59,3%. U razdoblju oftalmološkog praćenja 1995-1997. svega je 9 (18%) bolesnika primalo HAART, a u razdoblju 1998- 2000. 33 (70,2%). Ukupno je zabilježeno 208 patoloških promjena na očima: u prvom razdoblju 132 (63,5%), a u drugom razdoblju 76 (36,5%). Najčešće su dijagnosticirane vaskulame promjene (u 113/208, tj. 54,3% slučajeva), i to pamučasti eksudati (55 slučajeva) i mikroneurizme (54 slučaja). Od infektivr1ih promjena najčešće je dijagnosticiran citomegalovirusni retinitis (ukupno 39 epizoda). Promjene u prednjem segmentu očne jabučice relativno su rijetko opažene, u 11/208 (5 ,3%) slučajeva, a neurooftalmoloških manifestacija bilo je 39/208 (18,7%). Incidencija epizoda CMV-retinitisa u prvom razdoblju praćenja iznosila je 57,2 (95% IP 38,5 do 86,6) na 100 godina praćenja, a u eri HAART-a 7,6 (95% IP 1,6-22,4; P<0,0001) na 100 g. praćenja. Bolesnici iz ere HAART-a imali su značajno bolje očuvanu oštrinu vida kod kontrolnih pregleda u usporedbi s bolesnicima prije ere HAART-a (P<0,001). Naše istraživanje pokazuje zr1ačajno smanjenje incidencije CMV-retinitisa u razdoblju 1998-2000, pad incidencije ostalih očnih manifestacija bio je manje izražen. Za razliku od ere prije HAART-a, nije bilo pogoršanja oštrine vida u bolesnika iz ere HAART-a.
Summary
Summary. The aim of this study was to determine and compare the incidence of various ophthalmlogic changes before anfd after the initiation of highly active antiretroviral therapy (HAART) in HIV-infected patients treated at the University Hospital for Infectious Diseases »Dr. Fran Mihaljevi}« in Zagreb. This retrospective longitudinal analysis included all adult patients with confirmed HIV-1 infection divided into two groups: period before HAART (1995–1997) and period after HAART (1998– 2000). Only those patients who underwent at least two ophthalmologic examinations in any of the two or in both periods were considered eligible. In total, 85 patients were enrolled in the study, 50 during the 1995–1997 period and 47 in the period 1998– 2000 (12 patients were monitored in both periods). The mortality rate was significantly lower in patients treated during the HAART era, with an average decrease in mortality rates of 59.3%. During the period of ophthalmologic monitoing from 1995 to 1997, only 9 (18%) patients received HAART, and 33 (70.2%) in the period 1998–2000. In total, 208 ophthalmic abnormali- ties were recorded, 132 (63.5%) in the first and 76 (36.5%) in the second period. Vascular changes were most frequently diagnosed (113/208 or 54.3% cases) of which cotton-wool exudates in 55 and microaneurysms in 54 cases. Cytomegalovirus (CMV) retinitis was most commonly diagnosed among infectious ocular complications (altogether 39 episodes). Changes in the anterior segment were observed in only 11/208 (5.3%) cases, while neuro-ophthalmic manifestations were sees in 39/208 patients (18.7%). The incidence of CMV-retinitis episodes in the first monitored period was 57.2 (95% CI, 38.5–86.6) per 100 years of follow-up and in the HAART era 7.6 (95% CI, 1.6–22.4; p<0.0001) per 100 years of follow-up. The visual acuity in patients from the HAART era was significantly more frequently preserved than in patients from the pre HAART era on follow- up examinations (p<0.001). Our study showed that the incidence of CMV-retinitis declined significantly in the period 1998– 2000, ehile the decrease in the incidence rates of other ocular manifestations was less profound. In contrast to the pre HAART era, there was no worsening of visual acuity in the HAART era.
