人类免疫缺陷病毒感染者和获得性免疫缺陷综合征患者眼部病变相关的基础与临床研究

  目的  总结北京协和医院眼科诊治的人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染者和获得性免疫缺陷综合征(acquired immunodeficiency syndrome, AIDS)患者眼部病变的发病率及其临床特征、治疗效果和房水、泪液病毒学检测结果。  方法  回顾性分析2001年1月至2015年12月在北京协和医院眼科诊治的223例HIV/AIDS患者的眼部并发症的临床特征和治疗效果。其中男性157例, 女性66例; 平均年龄(39.2±9.7)岁(8.0~78.0岁)。对所有患者的感染方式、眼部并发症的临床表现、检查、治疗等进行回顾性分析。  结果  223例HIV/AIDS患者中, 有眼部并发症者99例(44.4%), 共156只眼, 其中并发巨细胞病毒(cytomegalovirus, CMV)视网膜炎64只眼(40例), HIV视网膜病变54只眼(35例), HIV/梅毒双重感染合并眼底病变20只眼(13例), 免疫重建炎症综合征(immune reconstitution inflammatory syndrome, IRIS)16只眼(10例), 慢性泪腺炎2只眼(1例)。CD4⁺T淋巴细胞计数小于50/mm³的HIV/AIDS患者泪液分泌低于正常人(P=0.008)。在行高效抗逆转录酶病毒疗法(highly active antiretroviral therapy, HAART)治疗有效且血浆HIV检测为阴性的16例HIV/AIDS患者的泪液中发现HIV-1病毒, 中位病毒载量为2291(519, 6667)拷贝/ml。  结论  在HIV/AIDS患者眼部病变中, CMV视网膜炎是AIDS晚期最常见的机会性感染, 早期发现和及时给予全身及眼部治疗, 可改善患者的视力预后。患者血液HIV检测阴性时, 房水和泪液HIV仍持续阳性, 提示防止HIV病毒播散, 采取有效的预防措施至关重要。

Basic and Clinical Research Related to Ocular Complications in Human Immunodeficiency Virus Infection/Acquired Immunodeficiency Syndrome Patients

  Objective  To review the clinical features, treatment effectiveness, and aqueous humor and tear virus load results of the ocular complications in human immunodeficiency virus infection/acquired immuno-deficiency syndrome (HIV/AIDS) patients diagnosed and treated in Department of Ophthalmology in Peking Union Medical College Hospital.  Methods  We retrospectively reviewed the clinical features and treatment effectiveness of ocular complications in 223 HIV/AIDS patients in the period from January 2001 to December 2015, including 157 males and 66 females. The mean age was (39.2±9.7) (8.0-78.0) years. Their HIV exposure, clinical manifestations of ocular complications, diagnostic examinations, and treatment were reviewed.  Results  Ocular manifestations were found in 99 (44.4%, 156 eyes) of the 223 patients, including cytomegalovirus retinitis (CMVR) in 64 eyes (40 patients), HIV retinopathy in 54 eyes (35 patients), HIV and syphilis double infection with fundus disease in 20 eyes (13 patients), immune reconstitution inflammatory syndrome (IRIS) in 16 eyes (10 patients), and chronic dacryoadenitis in 2 eyes (1 patient). Tear secretion was lower in HIV/AIDS patients with CD4+T cell less than 50/mm3 than in normal people (P=0.008). HIV-1 virus was found in the aqueous humor and tears of 16 HIV/AIDS patients responding to highly active antiretroviral therapy (HAART) and with undetectable plasma viral load, with the median viral load being 2291 (519, 6667) copies/ml.  Conclusions  CMVR is the most common opportunistic infection among the ocular complications of late-stage HIV/AIDS patients. Early diagnosis and systematic/topical treatment may save the vision of most patients. Detectable viral load may still be present in aqueous humor and tears even in patients with undetectable viral load in the blood, suggesting that precautions should be taken to prevent transmission of HIV virus.