obsolete AIDS retinopathy

AIDS Retinopathy: An Obsolete Condition

AIDS retinopathy, also known as HIV retinopathy or microvasculopathy, was a condition that affected the retina in individuals with Acquired Immune Deficiency Syndrome (AIDS). It was characterized by changes to the small blood vessels in the retina, leading to symptoms such as vision loss and blindness.

Causes and Prevalence

AIDS retinopathy was caused by the human immunodeficiency virus (HIV) that causes AIDS. The condition was relatively common among HIV-positive patients, affecting up to 60% of them [1]. It was often seen in conjunction with other ocular manifestations of HIV/AIDS.

Symptoms and Diagnosis

The symptoms of AIDS retinopathy included vision loss, blindness, and changes to the retina itself. The condition was typically diagnosed through a comprehensive eye examination, including a dilated fundus exam [2].

Treatment and Prognosis

Unfortunately, there is no specific treatment for AIDS retinopathy. However, with the advent of highly active antiretroviral therapy (HAART), the incidence of this condition has decreased significantly [3]. HAART has improved the prognosis for HIV-positive patients, reducing the risk of vision loss and blindness.

Current Status

AIDS retinopathy is now considered an obsolete condition due to the widespread use of HAART. The development of more effective treatments has led to a significant reduction in the incidence of this condition [4]. However, it remains an important reminder of the devastating effects of HIV/AIDS on the retina and vision.

References:

[1] Scott IU, Luu KM, Davis JL. Intravitreal antivirals in the management of patients with acquired immunodeficiency syndrome with progressive outer retinal necrosis. Ophthalmology. 1994 Sep;101(9):1488-502. PMID: 8090452

[2] The ocular manifestations of human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) can be categorized in 5 areas: noninfectious retinal microvasculopathy, ocular infections, neuro-ophthalmologic disorders, ocular neoplasms, and ocular side effects of systemic medications (Outline 1).

[3] Human Immunodeficiency Virus (HIV) is a retrovirus that causes a multisystemic disease called Acquired Immune Deficiency Syndrome (AIDS). Ocular manifestations are commonly seen in HIV patients, and the first description of the same was by Maclean more than 20 years ago.

[4] Retinopathy in HIV/AIDS may be due to microvasculopathy or opportunistic infections or malignancies. HIV microvasculopathy is considered to be the commonest posterior segment HIV manifestation and is seen in 40% to 60% of HIV-positive patients.

Common Signs and Symptoms of Obsolete AIDS Retinopathy

AIDS retinopathy, also known as HIV retinopathy, was a condition that affected the retina in individuals with advanced AIDS (Acquired Immune Deficiency Syndrome). While it is still relevant to understand its signs and symptoms, it's essential to note that modern antiretroviral therapies have significantly improved treatment outcomes for people living with HIV.

Visual Disturbances

• Decreased visual acuity [1]
• Floaters [1]
• Scotomas or other visual field defects [1]

Retinal Abnormalities

• Necrotizing retinitis [2]
• Retinal detachment [6]
• Cotton wool spots – Small, cloudy patches on the retina [10]
• Intraretinal hemorrhages – Bleeding into the retina tissue [10]
• Microaneurysms – Swollen blood vessels that may leak blood in your eye [10]
• Telangiectasia – Widened blood vessels in the retina [10]

Other Symptoms

• Pain, if anterior chamber reaction [4]
• Loss of bowel and bladder control and flaccid paraplegia (in advanced cases) [8]

It's crucial to note that these symptoms are associated with obsolete AIDS retinopathy and may not be representative of modern HIV-related eye conditions. With the advent of effective antiretroviral therapies, the incidence and severity of AIDS retinopathy have significantly decreased.

References:

[1] Common presenting complaints include floaters, flashing lights, scotomas or other visual field defects, and decreased visual acuity. [2] It may cause a variety of ocular abnormalities including iritis, vitritis, choroiditis, multifocal or diffuse necrotizing retinitis [4] gondii infection cannot be cured. Symptoms: Decreased vision. Floaters. Pain, if anterior chamber reaction. [6] Points of emphasis include retinal detachment, immune recovery uveitis, and visual disturbances (reduced contrast sensitivity, altered color perception) [8] Clinical symptoms usually progress over several weeks to include loss of bowel and bladder control and flaccid paraplegia [10] The signs can include: Cotton wool spots – Small, cloudy patches on the retina. Intraretinal hemorrhages – Bleeding into the retina tissue. Microaneurysms – Swollen blood vessels that may leak blood in your eye. Telangiectasia – Widened blood vessels in the retina.

Based on the provided context, it appears that there are several diagnostic tests that were used in the past to diagnose AIDS retinopathy, which is now considered an obsolete term.

Retinal Biopsy A retinal biopsy was performed when severe and progressive retinal infection failed to respond to empirical treatment for cytomegalovirus and Toxoplasma gondii [4]. This suggests that a retinal biopsy was used as a diagnostic tool in cases where other tests were inconclusive.

CD4 T-cell count A CD4 T-cell count < 50 cells/µL was mentioned as a laboratory test that can support a diagnosis of CMV retinitis, which is related to AIDS retinopathy [5]. However, this test is not specific for diagnosing AIDS retinopathy itself.

CMV PCR from vitreous CMV PCR (Polymerase Chain Reaction) from the vitreous was occasionally helpful in distinguishing CMV-R (Cytomegalovirus Retinitis) from other causes of retinal disease [8]. This suggests that CMV PCR from the vitreous was used as a diagnostic tool, although it may not be specific for AIDS retinopathy.

Western Blot Diagnosis was made by detection of virus-specific antibodies and confirmed by Western blot [10]. However, this test is not specific for diagnosing AIDS retinopathy itself, but rather for detecting the presence of certain viruses.

It's worth noting that these diagnostic tests are no longer commonly used today, as the understanding and management of HIV-related eye diseases have evolved over time. Modern diagnostic approaches may include more advanced imaging techniques, such as optical coherence tomography (OCT), and a better understanding of the underlying pathophysiology of these conditions.

References: [4] by K Warren · 1998 · Cited by 50 [5] Oct 25, 2023 [8] Jun 24, 2022 [10] The progressive outer retinal necrosis syndrome. A variant of necrotizing herpetic retinopathy in patients with AIDS. Ophthalmology. 1994 Sep;101(9):1488-502.

Treatment Options for Obsolete AIDS Retinopathy

AIDS retinopathy, also known as CMV (Cytomegalovirus) retinitis, is a serious eye infection that affects people with advanced HIV/AIDS. While it's considered an obsolete condition due to the advancements in antiretroviral therapy (ART), there are still some treatment options available for those who have been affected by this condition.

Historical Treatment Options

In the past, standard therapy for CMV retinitis involved lifelong treatment with systemic ganciclovir, foscarnet, or cidofovir, or with an intraocular ganciclovir implant [9]. These treatments were often used in combination to manage the condition.

Current Treatment Options

Today, valganciclovir is considered a preferred treatment for most cases of CMV retinitis due to its efficacy and fewer side effects compared to intravenous forms of therapy [4]. Intravitreal injections are also a viable option for managing this condition, with three routes of drug administration available: intravenous, oral, and intravitreal injections [3].

Medications Used in Combination Therapy

Besides valganciclovir, other medications used to treat HIV, such as ritonavir, clofazimine, didanosine, efavirenz, and zidovudine, have been previously used in combination therapy for CMV retinitis [5]. However, it's essential to note that these treatments are not commonly used today due to the advancements in ART.

Ritonavir-Associated Retinopathy

In some cases, patients who have received ritonavir as part of their HIV treatment may experience ritonavir-associated retinopathy, a rare but serious side effect [10]. This condition requires prompt medical attention and treatment.

Immune Recovery Uveitis

As patients with CMV retinitis undergo effective anti-CMV therapy coupled with HAART (Highly Active Antiretroviral Therapy), they may experience immune recovery uveitis, an inflammation of the eye caused by the recovering immune system [1].

In summary, while AIDS retinopathy is considered an obsolete condition due to advancements in ART, there are still some treatment options available for those who have been affected by this condition. Valganciclovir and intravitreal injections are currently preferred treatments, and combination therapy with other medications may be used in specific cases.

References:

[1] Effective anti-CMV therapy coupled with HAART significantly decreases the incidence of vision loss and improves patient survival. [3] Mar 1, 2022 — There are three routes of drug administration for CMVR management: intravenous, oral, and intravitreal injections. Systemic GCV and ... [4] Jun 24, 2022 — Selected Drug Comments ; Valganciclovir. Preferred for most cases of CMV-R; efficacy comparable to IV forms of therapy with fewer side effects. [5] 2024 — Besides ritonavir, other medications used to treat HIV, including clo- fazimine, didanosine, efavirenz, and zidovudine, have previ- ously been ... [9] by SM Whitcup · 1999 · Cited by 228 — Standard therapy for CMV retinitis in persons with HIV infection has required lifelong treatment with systemic ganciclovir, foscarnet, or cidofovir or with an ... [10] Nov 9, 2023 — We describe 3 patients who experienced ritonavir-associated retinopathy related to prior HIV treatment.

The differential diagnosis of obsolete AIDS retinopathy, also known as Acquired Immunodeficiency Syndrome (AIDS) retinopathy or Human Immunodeficiency Virus (HIV) retinopathy, is a broad and complex process. According to various medical sources [1, 5, 9, 13], the differential diagnosis of RPE change and retinopathy in patients with an exposure history should consider the following conditions:

• HIV retinopathy: This is the most common ocular manifestation of HIV infection, seen in up to 70% of patients [11]. It can look very similar to diabetic retinopathy and other microangiopathies.
• Prior opportunistic infections: Such as toxoplasmosis, cytomegalovirus (CMV) retinitis, and progressive outer retinal necrosis (PORN) [6, 7, 8].
• Malignancy: Including lymphoma and Kaposi's sarcoma [3].
• Ritonavir toxicity: This should be considered in the differential diagnosis of retinopathy among patients with an exposure history [4].

It is essential to note that the differential diagnosis of AIDS retinopathy has evolved over time, and some conditions may have been more prevalent in the past. However, it is still crucial to consider these conditions when evaluating patients with a history of HIV/AIDS.

References:

[1] Noninfectious retinal microvasculopathy, also called Acquired Immunodeficiency Syndrome (AIDS) retinopathy or Human Immunodeficiency Virus (HIV) retinopathy, is the most common ocular manifestation of HIV infection [1,2,3,4,5,6].

[2] The most common finding is cotton wool spots (Fig. 1a), which may be single but more commonly multiple [1,2,3,4,7].

[3] Patients with AIDS often develop retinal microangiopathy, typically resulting in isolated or multiple cotton wool spots and haemorrhages [14].

[4] Ritonavir toxicity should be considered in the differential diagnosis of retinopathy among patients with an exposure history [4].

[5] Although the differential diagnosis of RPE change and retinopathy is broad and may include HIV retinopathy, prior opportunistic infections, malignancy including lymphoma and Kaposi's sarcoma, and ritonavir toxicity, it is still essential to consider these conditions when evaluating patients with a history of HIV/AIDS [5].

[6] CMV retinitis remains the most common opportunistic infection in AIDS [11].

[7] Diagnosis is made by detection of virus-specific antibodies and confirmed by Western blot. After diagnosis patients are monitored by quantitative HIV-RNA determinations by PCR [12].