HIV-associated retinal microangiopathy and the development of AIDS-defined infections. The Bern Angiopathy Study

Abstract

HIV-associated retinal microangiopathy is understood as a sign of uveovascular barrier breakdown and associated with an increasing risk to develop opportunistic infections. Hence no controlled studies have been available, the underlying study was undertaken to validate this clinical impression. HIV-positive patients with or without clinical signs of retinal angiopathy were included into this study and followed up longitudinally with fotodocumentation, laser-flare and, sporadically, fluorescein angiography to quantify the disturbance of their uveovascular barrier. The data were correlated to the CD4 cell counts and the development of opportunistic infections. 104 patients have been included into one of four groups: patients without signs over ocular vascular disease (group 1, n = 46), with newly diagnosed HIV-associated microangiopathy (group 2, n = 37), with angiopathy for more than six months (group 3, n = 16), and with viral retinitis (group 4, n = 5). We found no difference in the flare between patients with and without angiopathy (p = 0.3), but a significant increase after the development of retinitis (p < 0.001). In contrast, the presence and duration of angiopathy were associated with a reduction in CD4 cell counts (p = 0.03). Using fluorescein angiography, we found vascular occlusions on the capillary level without leakages corresponding to a not relevant disruption of the retinovascular barrier. In HIV-associated retinal microangiopathy, there exists no relevant disturbance of the uveovascular barrier. The association of angiopathy with a reduction of CD4 cells is more likely a sign of immuncomplex-associated rather than infectious etiology. The analysis of drug effects on the course of angiopathy during a recovery of the cellular immunity will provide further etiological information in the progress of this study.