In the article posted last Friday April 03, 2015 we provide general information about the eye aging and age-related macular degeneration (AMD) of CATIE, in this article we focus on reports of AMD (age-related macular degeneration) in HIV-positive patients.
Researchers at Mount Sinai Hospital in New York City and elsewhere in the United States have been monitoring the eye health of people who have survived AIDS thanks to the application of ART (Antiretroviral Therapy, since mid-1996).
They found that, of the 1.825 participants, 10% performed at an intermediate AMD stage. Regarding HIV-negative people, the rate of AMD among these long-term AIDS survivors was four times higher. The results and implications of this study are discussed below.
Researchers in 19 cities in the United States recruited participants in an eye health study.
Recruitment began in 1998 and ended in 2011. All participants had been diagnosed with AIDS, some with ophthalmic complications. As part of the study, photographs of the retina of each eye of all study subjects were taken and evaluated. For the present analysis, centered on AMD (AMD or Age-Related Macular Degeneration in free translation); the researchers did not use the medical histories of people who had AIDS and eye complications already in the recruitment phase.
The average profile of the participants when entering the study was as follows:
- 81% Of men, 19% of women
- Age - 43 years
- CD4 + lymphocyte count - 198 cells / mm3
- Lowest CD4 + count in the study period = 44 cells / mm3
- Viral load - approximately 500 copies / ml
- Highest viral load during the study - 20.000 copies / ml
A note from the editor. The percentage disparity in the sex of the research subjects seems overwhelming and, however, it reflects two things, one of which is particularly worrying: In 1998, there was still a big difference between the number of HIV-positive men and women and, over time, this disparity has changed and, in certain regions and in certain age groups, there is already a greater number of HIV-positive women, which reveals what I, in the mid-2000s, realized that the number of women diagnosed as HIV positive was beginning to grow, and in short, today it is already known that women are extremely more vulnerable to HIV and AIDS due to factors such as misogyny, violence against women, difficulty in negotiating condom use in the relationship between Women vs men (OH not capitalized is purposeful), irresponsible infidelity (translator's note: I translate my thoughts in a simple way: You don't know how to stick to the domestic thalamus, at least have the decency to use condoms in relationships outside of marriage, damn it), rape in marriage and countless atrocities perpetrated against women and, in people who, although they do not have a specific morphological definer, actually feel like women).
Almost 10% of the participants had an intermediate AMD stage. People with this diagnosis can easily develop visual impairment and, in some cases, this worsens over time, which can lead to permanent and irrecoverable blindness.
Potential risk factors
Researchers analyzed several potential factors that participants had at the time they entered the study and found that the following data were statistically associated with an increased risk for AMD:
- Age group - for every ten years over the age of 29, participants had twice the risk of developing AMD processes
- Risk behavior for contracting HIV - Injecting Drug Users (IDUs) or people who define themselves as heterosexuals were about twice as likely to develop AMD processes compared to homosexual and bisexual men.
The researchers compared the rates of AMD in data collected from HIV-negative people, through a study involving thousands of people in the town of Beaver Dam in Wisconsin (which became known as “The Beaver Dam Study).
In this study, participants also underwent extensive eye exams.
In comparison, the researchers found that HIV-positive people in the present study showed statistically four times more risk of developing AMD processes than the group of HIV-positive people.
Observe, analyze and keep in mind.
The present analysis of AMD in seropositive people is transversal. That is, the data for a given point in time were evaluated; therefore, drawing conclusions about possible cause (s) of AMD processes from such research needs to be evaluated in a meticulous and careful manner.
The potential causes of AMD mentioned in the present study are interesting and seem to make sense intuitively.
For example, age is a known risk factor for AMD and the researchers stated that, with their experience, injecting drug users (IDUs) are at increased risk for AMD processes.
Readers should be aware that even if the results of the present study are XNUMX% accurate (which is very rare in medicine), they are unlikely to apply to all HIV positive people.
This is because many of the participants had a very low CD4 + count in the past (less than 50 cells / mm3), which suggests that they had severe immunological problems at some point in their lives and cannot be measured, with the exception of patients who conserve religiously their medical histories, to which infectious processes they have been subjected to by the forces of Nature.
This low CD4 + count could have predisposed participants to greater inflammation (for example: some long-term surviving patients may develop vasculitis, which may lead to a greater propensity for the generation of thrombi - clots in the bloodstream - and to develop Repeated Lung Thrombus Embolism, which is the case of this citizen, who, at the moment, translates the text, has already survived two pulmonary embolisms and two meningitis ...) and other problems related to the immune system, thus increasing the risk of AMD .
Over the past few years, in countries with economies with high income-per-capita, clinical practice and treatment guidelines have been encouraging for the early initiation of antiretroviral therapy (commonly called ART or HAART), thus avoiding this low CD4 + count (and the consequent immune damage) and is less likely today. Therefore, the study's findings may not apply to people whose CD4 + count has never dropped to such low levels.
The reasons for the increased risk of AMD among this group of HIV-positive patients are not certain and there is still a lot to study.
However, researchers at Monte Sinai Hospital suspect that factors such as excessive immune activation and inflammation prior to the onset of ART in the study participants' lives may have played an important and not yet measurable role.
Other clinics should assess whether or not they consider the findings of the study conducted at the Hospital Monte Sinai in the United States.
This information was provided by CATIE (Canada AIDS Information Exchange). For more information, contact CATIE, 1.800.263.1638 or by e-mail Catie. The credit must appear in any online publication, with a link back to the original. The Brazilian Portuguese translation cannot be used without the prior written authorization of those responsible for the Soropositivo Web Site, subjecting the infringer to the possible implications of the laws covering intellectual property rights. Note that, in general, I will hardly deny the use of the text itself, provided the credits are given. I also ask for a link to the website, in the following composition: http://soropositivo.org/ This is due to the fact that I have to pay a certain amount annually to maintain some, the improvements, such as mapping for domains, space for images, VideoPress video services and, of course, my absolute certainty that, one day, I am going to die and I am not able to predict whether my descendants or other people, or perhaps even AUTTOMATIC, can guarantee the functioning of the same in the current molds, after my passage ... However, the exact replication of the page, making use of the images that I am forced to buy to maintain some originality and not fall into the sameness, I will not authorize. If you want to get good quality photos at good prices, click on this link, which opens in another tab and another site. Thank you
However, it should be borne in mind that at least the results of the study point to the need for HIV-positive people to have regular and comprehensive eye care so that doctors can detect cases of AMD processes (and any other ophthalmic complications) quickly. and, when possible, prescribe treatments to stabilize, alleviate or cure that condition.
Brasil with “S” because it does not exist Brasil with “z” and “BraZil” with “z” is na idiomatic aberration created for persons that only God (and with great possibility of The devil) knows why they do this and which obscure intention they may have ...Management of Human Immunodeficiency Virus Infection in Advanced Age Long-term HIV infection and health-related quality of life - CATIE News Dutch doctors explore intersection of aging and HIV - CATIE News Report to the NIH about Aging and HIV The CIHR Comorbidity Agenda CIHR's HIV Comorbidity Research Agenda: Relevant Research Areas HIV and Aging - Healthy Living tips for men 50 years and older living with HIV HIV and Aging - CATIE Webinar Series: Building Blocks Factsheets on HIV and aging in Canada - Canadian AIDS Society Evidence-informed recommendations for rehabilitation with older adults living with HIV: a knowledge synthesis -Sean R. flexible pipe REFERENCE: Jabs DA, Van Natta ML, et al. Prevalence of intermediate-stage age-related macular degeneration in patients with the acquired immunodeficiency syndrome. American Journal of Ophthalmology. 2015; in press.
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