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 > or =100 in 63.6% and > or =200 in 43.0%. Cytomegalovirus (CMV) retinitis was present in 22.1%, whereas other ocular opportunistic infections each were present in < or =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.