Pazienti HIV in terapia antiretrovirale e malattie oculari

[Eilan]

In sintesi vi è una prevalenza di cataratta in pazienti HIV in terapia, rispetto alla popolazione generale, quello che è preoccupante è che si verificano in persone sulla quarantina, quindi pazienti più giovani della media. Hanno identificato 44 diverse diagnosi che riguardano gli occhi.
Non vi è correlazione tra conta dei CD4 e sviluppo di cataratta.


HIV-positive patients receiving highly active antiretroviral therapy (HAART) have a prevalence of cataracts that is well above that of the general population and a plethora of other ocular diseases, researchers reported here at the American Academy of Ophthalmology 2011 Annual Meeting.

What is particularly alarming is the fact that the cataracts are occurring in a much younger population, presenter Brian Toussaint, MD, from Georgetown University Hospital and Washington Hospital Center, DC, told Medscape Medical News.

"We are even seeing people in their mid-40s. In our study, which looked at 102 patients, 40% of patients aged 40 to 49 had cataracts; nationally, only 2.5% of people in that age range have cataracts. In the 50- to 59-year age group, 72% had cataracts; nationally, that rate is 6.8%," Dr. Toussaint said. "The doctors in my group are having to do cataract surgery on patients in their 40s, when normally we are looking at doing cataract surgery on patients in their 60s."


Dr. Brian Toussaint
In this retrospective review, Dr. Toussaint and his team identified 44 different diagnoses among HIV patients receiving HAART. The most common was refractive error (58 patients), followed by nuclear cataracts (42 patients), suspected glaucoma (13 patients), and dry eye syndrome (10 patients). Other diagnoses included punctate epithelial erosion, blepharitis, hypertension retinopathy, posterior subcapsular cataract, primary open-angle glaucoma, exotropia, herpes zoster, superficial punctate keratopathy, myopic degeneration, chronic retinal detachment, HIV retinopathy, corneal abrasion, and central retinal vein occlusion.

Of note, there were no cases of cytomegalovirus retinitis, Dr. Toussaint reported.

Additionally, there was no correlation between CD4 count and the development of cataracts.

Dr. Toussaint pointed out that the retroviral protease of HIV-1 can cause cataract formation; when this is inhibited, cataract formation is prevented. However, in this review, there was no statistically significant difference in cataract formation between people who were taking protease inhibitors and those who were not.

"The odds ratio for cataracts was 7% lower for patients on protease inhibitors [odds ratio, 0.93; 95% confidence interval, 0.42 to 2.05]. While this could be said to be somewhat protective, it was not significant," Dr. Toussaint explained.

The ophthalmologic exam is vital to the care of these patients, he added. "We identified 44 different diagnoses, and most of the time the patients just came in saying 'I've got blurry vision.' Practitioners need to be vigilant and give them a thorough work-up."

http://www.medscape.com/viewarticle/752667

[Tarek]

...mo' anche la cataratta? è meglio che cominci anche io a prendere gli integratori...

[Eilan]

In realtà li prescrivono davvero, e sono a base di carotenoidi, omega3, e zinco. Mia madre è già stata operata in entrambi gli occhi anni fa, ma ora gli stanno ritornando, e l'oculista glieli ha prescritti.
Poi che facciano qualcosa non lo so, ne ha presi 2 e poi ha mollato, il prezzo è di 40 euro.

[Tarek]

Be', qui in brasile li vendono, Meli, se mi dici quali prendeva tua mamma... poi parlo col mio medico e sento cosa dice. Comunque un abbassamento della vista ce l'ho da parecchi anni e non la controllo da un po'. Il mio compagno che era in aids nel 1995 e aveva il citomegalovirus è stato operato di cataratta nel 2001 quando aveva 35 anni.

[carletto]

Dillo anche a me Meli che presto devo andare dall'oculista e gli chiedo..