Abstract
PurposeTo compare peripapillary retinal nerve-fiber–layer (pRNFL) thickness, total retina macular volume, and ganglion-cell-layer (GCL) macular volume and thickness between persons living with HIV (PLHIVs) with well-controlled infections and good immune recovery, and sex- and age-matched HIV-uninfected controls (HUCs).MethodsThis prospective cross-sectional study (www.clinicaltrials.gov identifier: NCT02003989) included 56 PLHIVs, infected for ≥10 [median 20.2] years and with sustained plasma HIV-load suppression on combined antiretroviral therapy (cART) for ≥5 years, and 56 matched HUCs. Participants underwent spectral-domain optical coherence tomography (SD-OCT) with thorough ophthalmological examinations and brain magnetic resonance imaging (MRI). Their overall and quadrant pRNFL thicknesses, total macular volumes, and GCL macular volumes and thicknesses were compared. Cerebral small-vessel diseases (CSVD) complied with STRIVE criteria.ResultsMedian [interquartile range, IQR] ages of PLHIVs and HUCs, respectively, were 52 [46–60] and 52 [44–60] years. Median [IQR] PLHIVs’ nadir CD4+ T-cell count and current CD4/CD8 T-cell ratio were 249/μL [158–350] and 0.95 [0.67–1.10], respectively; HIV-seropositivity duration was 20.2 [15.9–24.5] years; cART duration was 16.8 [12.6–18.6] years; and aviremia duration was 11.4 [7.8–13.6] years. No significant between-group pRNFL thickness, total macular volume, macular GCL-volume and -thickness differences were found. MRI-detected CSVD in 21 (38%) PLHIVs and 14 (25%) HUCs was associated with overall thinner pRNFLs, and smaller total retina and GCL macular volumes, independently of HIV status.ConclusionsSD-OCT could not detect pRNFL thinning or macular GCL-volume reduction in well-sustained, aviremic, cART-treated PLHIVs who achieved good immune recovery. However, CSVD was associated with thinner pRNFLs and GCLs, independently of HIV status.
Highlights
cerebral small-vessel disease (CSVD) was associated with thinner peripapillary retinal nerve-fiber–layer (pRNFL) and GCLs, independently of human immunodeficiency virus (HIV) status
Combined antiretroviral therapy ensures human immunodeficiency virus (HIV) suppression and immunological recovery in a majority of persons living with HIV (PLHIVs), dramatically improving life expectancy [1,2]
Aging PLHIVs’ life expectancy persistently lags behind that of the general population, predominantly because of their heightened risk for age-related comorbidities, to which they might be more vulnerable [7,8]. Among those age-related comorbidities, magnetic resonance imaging (MRI)-detected [9] cerebral small-vessel disease (CSVD) prevalence is doubled in Combined antiretroviral therapy (cART)-treated, immunovirologically well-controlled, middle-aged PLHIVs compared to age-matched HIV-uninfected individuals [10]
Summary
Combined antiretroviral therapy (cART) ensures human immunodeficiency virus (HIV) suppression and immunological recovery in a majority of persons living with HIV (PLHIVs), dramatically improving life expectancy [1,2]. Aging PLHIVs’ life expectancy persistently lags behind that of the general population, predominantly because of their heightened risk for age-related comorbidities, to which they might be more vulnerable [7,8]. Among those age-related comorbidities, magnetic resonance imaging (MRI)-detected [9] cerebral small-vessel disease (CSVD) prevalence is doubled in cART-treated, immunovirologically well-controlled, middle-aged PLHIVs compared to age-matched HIV-uninfected individuals [10]. The results of several studies [12,13,14,15] documented the cognitive impact of CSVD-surrogate WMHs on cART-treated PLHIVs with long-term virus suppression, leading to the recent paradigm of vascular-driven, milder HAND forms [16]
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