American journal of ophthalmology 2017 05 09() pii 10.1016/j.ajo.2017.05.004
To evaluate the incidence of intermediate-stage age-related macular degeneration (AMD) in patients with the acquired immunodeficiency syndrome (AIDS).
Patients enrolled in the Longitudinal Study of the Ocular Complications of AIDS (LSOCA) underwent 5- and 10-year follow-up retinal photographs. Intermediate-stage AMD (AREDS stage 3) was determined from these photographs by graders at a centralized Reading Center, using the Age-Related Eye Disease Study-2 grading system. The incidence of AMD in LSOCA was compared to that in the Multi-Ethnic Study of Atherosclerosis (MESA), a Human Immunodeficiency Virus (HIV)-uninfected cohort, which used a similar photographic methodology.
The incidence of AMD in LSOCA was 0.65/100 person-years (PY). In a multivariate analysis the only significant risk factor for AMD in LSOCA was smoking; the relative risk vs never smokers was 3.4 for former smokers (95% confidence interval [CI] 1.3, 9.5; P=0.02) and 3.3 for current smokers (95% CI 1.1, 9.7; P=0.03). Compared to the MESA cohort, the race/ethnicity- and gender-adjusted risk of AMD in LSOCA was 1.75 (95% CI 1.16, 2.64; P=0.008), despite the fact that the mean age of the MESA cohort was 17 years greater than the LSOCA cohort (61 + 9 years vs 44 + 8 years).
Patients with AIDS have a 1.75-fold increased race- and gender-adjusted incidence of intermediate-stage AMD compared with that found in an HIV-uninfected cohort. This increased incidence is consistent with the increased incidence of other age-related diseases in antiretroviral-treated, immune-restored, HIV-infected persons when compared to HIV-uninfected persons.