Retinal Nerve Fiber and Optic Disc Morphology in Patients with Human Immunodeficiency Virus Using the Heidelberg Retina Tomography 3.

Dirk-Uwe Bartsch,Byung Ro Lee,Igor Kozak,Victoria L Knudsen,Igor Grant,William R Freeman,Robert N Weinreb

doi:10.1371/journal.pone.0133144

Abstract

PurposeTo use novel confocal scanning ophthalmoscopy technology to test hypothesis that HIV-seropositive patients without history of retinitis with a history of a low CD4 count are more likely to have damage to their retinal nerve fiber layer (RNFL) when compared to patients with high CD4 count. In addition, we compared optic disc morphologic changes with glaucoma.DesignCross-sectional study.Participants and Controls171 patients were divided into four groups. The control group consisted of 40 eyes of 20 HIV-seronegative patients. The second group consisted of 80 eyes of 41 HIV-positive patients whose CD4 cell count never dropped below 100 (1.0 x 109/L). The third group consisted of 44 eyes of 26 HIV-positive patients with a history of low CD4 counts <100. Fourth group consisted of 79 eyes of 79 patients with confirmed glaucoma who served as positive controls.TestingConfocal scanning laser ophthalmoscopy was performed with the Heidelberg Retina Tomograph (HRT3) and data were analyzed with HRT3, software (Heyex version 1.5.10.0).Main Outcome MeasuresDisc area, cup area, cup volume, rim volume, mean cup depth, maximum cup depth, cup-to-disc ration, mean RNFL thickness, and RNFL cross-sectional area.ResultsAnalysis of the global optic nerve and cup parameters showed no difference in disk area among the four groups. There was also no difference in cup, rim volume, mean cup depth, or maximum cup depth among the first three groups but they were all different from glaucoma group. The RNFL was thinner in glaucoma and both HIV-positive groups compared to HIV-seronegative subjects. The cross sectional RNFL area was thinner in both high and low CD4 HIV-positive groups compared to HIV-seronegative group in the nasal and temporal/inferior sectors, respectively. Glaucoma group showed thinning in all sectors.ConclusionsHIV retinopathy results in retinal nerve fiber layer loss without structural optic nerve supportive tissue change. RNFL damage may occur early in HIV disease by mechanism different than in glaucoma.

Highlights

Human Immunodeficiency Virus (HIV) continues to be a major public health problem in the United States with 56,000 new human immunodeficiency virus (HIV) infections per year [1]
The retinal nerve fiber layer (RNFL) was thinner in glaucoma and both HIV-positive groups compared to HIV-seronegative subjects
The cross sectional RNFL area was thinner in both high and low CD4 HIV-positive groups compared to HIV-seronegative group in the nasal and temporal/ inferior sectors, respectively

Summary

Introduction

Human Immunodeficiency Virus (HIV) continues to be a major public health problem in the United States with 56,000 new HIV infections per year [1]. Since 1996, with the advent of potent highly active antiretroviral therapy (HAART), we see a significantly prolonged time between HIV infection and progression to acquired immunodeficiency syndrome (AIDS) and death in the United States [3] [4]. There is a cumulative effect of ongoing retinovascular disease that can be noted on clinical exam, including retinal nerve fiber layer (RNFL) infarcts [6] [7]. We have hypothesized that the documented retinovascular disease which results in retinal cotton wool spots, retinal hemorrhages and non perfusion likely leads to cumulative death of retinal ganglion cells and lesions in the retinal nerve fiber layer [10]

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