In the article posted last Friday 03 2015 April we provide general information on the aging of the eyes and age-related macular degeneration (AMD) of CATIE, in this article we focused on reports of AMD (Age Related Macular Degeneration) in HIV-positive patients.
Researchers at Mount Sinai Hospital in New York City and other parts of the United States have been tracking the health of the eyes of people who have survived AIDS through the application of antiretroviral therapy since mid-1996.
They found that, of the 1.825 participants, 10% were in an intermediate AMD stage. Regarding HIV-negative people, the rate of AMD among these long-term survivors of AIDS was four times higher. The results and implications of this study are discussed below.
Researchers in 19 cities in the US recruited participants from an eye health study.
Recruitment started at 1998 and ended at 2011. All participants had been diagnosed with AIDS, some with ophthalmological complications. As part of the study, retinal photographs of each eye of all study subjects were taken and evaluated. For the present analysis, focused on AMD (DMI or Macular Degeneration relative to Free translation age); the researchers did not use the medical histories of people who had AIDS and ocular complications already in the recruitment phase.
The average profile of participants entering the study was as follows:
- 81% Of men, 19% of women
- Age - 43 years
- CD4 + lymphocyte count - 198 cells / mm3
- CD4 + lowest score in the study period = 44 cells / mm3
- Viral load - approximately 500 copies / ml
- Highest viral load during study - 20.000 copies / ml
A note from the editor. The percentage disparity in the sex of the subjects of the survey seems excessive, and yet it reflects two things, one of which is particularly worrisome: In the wake of 1998 there was still a large difference between the number of HIV-positive people males to females and, over time, this disparity has been changing, and in certain regions and in certain age groups there are already a greater number of seropositive women, which reveals what, in the middle of the 2000 years, I realized that the number of women diagnosed as HIV positive began to increase, and, in short, it is now known that women are extremely vulnerable to HIV and AIDS because of factors such as misogyny, violence against women, negotiate condom use in the relationship between Woman vs. Man (OH not capitalized is purposeful), irresponsible infidelity (translator's note: I translate my thinking in a simple way: Do not know if to fix the domestic thalamus, at least have the decency to use condoms in relationships outside of marriage, bitch who gave birth), rape in marriage and an endless number of atrocities perpetrated against women and, in addition, people who, although they do not have a certain morphological definer, really feel like women).
Almost 10% of participants had intermediate stage DMARD. People with this diagnosis can easily develop visual impairment and, in some cases, it worsens over time, leading to permanent and irrecoverable blindness.
Potential risk factors
Researchers looked at 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 above the age of 29 years, participants had a two-fold increased risk of developing AMD
- Risk behavior for contracting HIV - Injecting drug users (IDUs) or self-defining heterosexuals were about twice as likely to develop AMD in relation to homosexuals and bisexual men.
The researchers compared the rates of AMD in data collected from HIV-negative people, through a study involving thousands of Beaver Dam city residents in Wisconsin (which became known as "The Beaver Dam Study").
In this study, participants also underwent extensive ophthalmologic examinations.
In comparison, the researchers found that HIV positive people in the current study statistically demonstrated four times more risk of developing AMD than the group of HIV-positive people.
Observe, analyze and keep in mind.
The present analysis of AMD in seropositive individuals is transversal. That is, data from a given point in time were evaluated; therefore, drawing conclusions about possible cause (s) of the AMRD processes for such research needs to be carefully and meticulously evaluated.
The potential causes of AMD named in this study are interesting and seem to make sense intuitively.
For example, age is a known risk factor for AMD and researchers have 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 100 percent 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 very low CD4 + count in the past (less than 50 cells / mm3), suggesting that they had severe immune problems at some point in life and can not be measured with the exception of patients who conserve religiously their medical histories, to which infectious processes they were subjected by the forces of Nature.
Such a low CD4 + count might have predisposed participants to greater inflammation (for example, some long-term surviving patients may develop vasculitis, which may lead to a greater propensity to thrombi - clots in the bloodstream - and Thrombo Pulmonary Embolism of repetition, which is the case of this citizen, who, at the moment, translates the text, has 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 high-income countries income-per-capita, clinical practice and treatment guidelines have been encouraging for the early initiation of antiretroviral therapy (commonly called HAART or HAART), thus avoiding this low CD4 + count (and consequent immune damage) and is less likely today. Therefore, the findings of the study may not apply to people whose CD4 + count had never fallen to such low levels.
The reasons for the increased risk of AMD among this group of HIV-positive patients are not right and there is still much to study.
However, researchers at Mount Sinai Hospital suspect that factors such as excessive immune activation and inflammation prior to initiation of HAART in the lifetime of study participants may have played a significant and still unmeasurable role.
Other clinics should evaluate whether or not they consider the findings of the study performed at the Mount Sinai Hospital in the USA.
However, it should be borne in mind that, at a minimum, the results of the study point to the need for HIV-positive people to have regular and comprehensive ophthalmologic follow-up so that physicians can detect cases of AMD (and any other ophthalmological complications) quickly and, where possible, prescribe treatments to stabilize, alleviate or cure such condition.
This information was provided by CATIE (Canada Exchange of AIDS treatment information). For more information, contact CATIE, 1.800.263.1638 or e-mail Catie. The credit must appear on any online publication, with a link back to the original.
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(And with great possibility of The devil) knows why they do this and which obscure intention they may have ...
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-Sean R. flexible tube no
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.