AIDS AND AMD STUDY

Compared with their uninfected, similarly aged counterparts, persons with HIV infection have higher rates of various age-related diseases, including cardiovascular disease, osteoporosis, diabetes and neurocognitive decline.

Now, intermediate-stage age-related macular degeneration (AMD) can be added to the list, according to an analysis of baseline data collected in the Longitudinal Study of the Ocular Complications of AIDS (LSOCA). The research was recently published (Jabs DA et al. Am J Ophthalmol. 2015;159:1115-1122) and was presented by Douglas A Jabs MD, MBA at the 2015 annual meeting of the Association for Research in Vision and Ophthalmology in Denver, USA.

The analysis included data from 1,825 patients with AIDS who had no ocular opportunistic infection(s). The participants ranged in age from 13 to 73 years with a mean age of 43.4 years.

Overall, 9.9 per cent of the participants were identified as having intermediate-stage AMD as determined by grading of baseline wide-field retinal photographs performed at the University of Wisconsin-Madison reading centre. Multiple regression analysis found age was a strong risk factor for intermediate-stage AMD, with the risk increasing nearly two-fold for every decade of age, and the prevalence rate reaching 16.8 per cent and 24.3 per cent in subgroups aged 50-59 and ≥60 years, respectively.

SIMILAR METHODS

Published data from the Beaver Dam Offspring Study was used for comparing the prevalence rate of intermediate-stage AMD in the LSOCA population to a non-HIV infected cohort, since retinal photographs in the two studies were graded at the same institution with similar methods. The results showed the AIDS patients had a four-fold higher age-adjusted prevalence of intermediate-stage AMD.

“Although the underlying mechanism leading to this increase in intermediate-stage AMD in persons with AIDS is not yet known, it may relate to the state of chronic immune activation and systemic inflammation seen in these patients,” said Dr Jabs, Professor of Ophthalmology and Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.

Consistent with that idea, the multiple regression analysis also found that AIDS patients who acquired HIV infection through injection drug use had a significantly increased risk of having intermediate-stage AMD compared with their counterparts acquiring disease by male-to-male sexual contact. The investigators noted that injection drug use itself is associated with immune activation and inflammation.

Accelerated immunosenescence, which also occurs in the setting of HIV disease, might also be contributing to the development of intermediate-stage AMD in AIDS patients. Dr Jabs and colleagues note that HIV-infected persons have immunologic changes similar to those seen in HIV-uninfected persons over 70 years of age.

Douglas A Jabs: douglas.jabs@mssm.edu