January 2017

 

NEWS & OPINION

 

Presentation spotlight

Patients with HIV at increased risk for developing AMD at a younger age


by Liz Hillman EyeWorld Staff Writer

 
   
HIV

Growing body of research shows patients with HIV are at risk for age-related diseases

Patients with AIDS are four times more likely to develop age-related macular degeneration (AMD), despite antiretroviral therapy, compared to people without HIV infection. The research, published in the American Journal of Ophthalmology, was presented by Douglas A. Jabs, MD, MBA, professor of ophthalmology and medicine, Icahn School of Medicine at Mount Sinai, New York, at the 2016 American Academy of Ophthalmology (AAO) annual meeting in Chicago. Dr. Jabs told EyeWorld the findings of this study add to a body of research that patients with HIV and AIDS experience an accentuated and accelerated aging process. “HIV-infected patients who are antiretroviral treated and immunorestored have immune systems that look like a 70-year-old’s,” Dr. Jabs said. “We think the accelerated aging is a consequence of chronic immune activation and systemic inflammation. … Inflammation is good in that it fights pathogens, but there is a downside, and the downside is it takes a toll on your body.” Dr. Jabs explained the phenomenon called immunosenescence, where there is an accumulation of terminally differentiated effector cells, cells that are committed to fighting pathogens. He also said there is a reduced amount of native T cells to help build a response to a new pathogen. In elderly patients, research has shown immune activation associated with systemic inflammation. They think this is also happening in patients with AIDS. Dr. Jabs said researchers have been following a cohort of patients with HIV since the mid-1990s; 99% of these patients had ocular photographs taken at baseline. The study included 1,825 patients with AIDS, 9.9% of whom were found to have intermediate-stage AMD. The prevalence of AMD in these patients was compared to a cohort of patients without HIV, where similar methods were used.

“We compared our prevalence to their prevalence, and adjusted for age. What we found was a four-fold greater likelihood for intermediate- stage AMD among patients with AIDS,” Dr. Jabs said, noting that this finding is consistent with what’s been seen of other age-related diseases in patients with HIV and AIDS. The age at which patients with AIDS were presenting with intermediate-stage AMD was also younger than what would usually be expected. “We noticed that although our cohort’s average age was mid-40s, we saw the features of intermediate-stage AMD, which you typically don’t see until someone is more than 50 years old,” Dr. Jabs said.

The research did not look at late-stage AMD and did not look at blindness related to AMD, Dr. Jabs said. As such, the study cannot say whether patients with AIDS are at an increased risk for blindness. Overall, Dr. Jabs said the results of this cross-sectional study are not going to change the way clinicians treat patients with HIV or AIDS, but the study may increase awareness. Early in the AIDS epidemic, before there was effective antiretroviral therapy, patients with AIDS were at high risk for infections of the eye, Dr. Jabs explained. But with modern antiretroviral therapy, the incidence of these infections has dropped, giving the sense that eye problems related to AIDS have been solved. This research regarding the higher potential for AMD in patients with AIDS at younger ages suggests “maybe there is another problem we should pay attention to,” he said. “Ophthalmologists should be checking their eyes in routine fashion and pay attention to whether they see evidence of age-related diseases or not,” Dr. Jabs said.

Going forward, Dr. Jabs said his team is looking at potential mechanisms and/or biomarkers that could be correlated with AMD and accelerated aging, specifically examining immunologic and inflammatory pathways.

Reference

1. Jabs DA, et al. Prevalence of intermediate-stage age-related macular degeneration in patients with acquired immunodeficiency syndrome. Am J Ophthalmol. 2015;159: 1115–1122.

Editors’ note: Dr. Jabs has no financial interests related to his comments.

Contact information

Jabs: douglas.jabs@mssm.edu

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