Longitudinal study of the ocular complications of AIDS - 1. Ocular diagnoses at enrollment

Objective: To report the prevalence of ocular complications of AIDS in the era of highly active antiretroviral therapy (HAART). Design: Cohort study. Participants: Patients with AIDS, 13 years or older. Methods: History, eye examination, and laboratory testing at enrollment. Main Outcome Measure: Frequency of ocular complications at enrollment. Results: As of March 31, 2003,1632 participants with AIDS were enrolled. The cohort had a history of severe immune deficiency, as evidenced by a median nadir CD4+ T-cell count of 30 cells per microliter. At enrollment, the median CD4+ T-cell count was 164 cells per microliter. CD4+ T-cell counts were < 50 in 24.1% but >= 100 in 63.6% and >= 200 in 43.0%. Cytornegalovirus (CMV) retinitis was present in 22.1%, whereas other ocular opportunistic infections each were present in <= 0.6%. The incidence of CMV retinitis estimated from retrospective data was 5.60/100 person-years. Of the 360 patients with CMV retinitis, 22.5% were newly diagnosed at enrollment, and the remainder had more long-standing CMV retinitis (median, 2.8 years). Conclusions: Although there is the possibility of oversampling patients with AIDS and ocular complications (as compared with a random sample), which would lead to increased estimates of prevalent and incident ocular morbidities, these data still suggest a substantial decline in the incidence of CMV retinitis from the pre-HAART era. Nevertheless, new cases of CMV retinitis continue to occur, and there is a population of patients with long-standing retinitis who will require management.