[A comparative study of retinal nerve fiber layer thickness in AIDS patients with different fundus diseases].

Objective: To investigate the characteristics of retinal nerve fiber layer (RNFL) thickness in AIDS patients with normal fundus, HIV-related microvascular retinopathy (MVR), and cytomegalovirus retinitis (CMVR). Methods: In this cross-sectional study, 111 patients were diagnosed with AIDS from 2012 to 2017 by infectious disease physicians in Beijing You'an Hospital. There were 105 males and 6 females, aged 20-65 years. According to the results of ophthalmic examination, the patients were divided into three groups: 31 patients in the active-stage CMVR group, 47 patients in the MVR group, and 33 patients with normal fundus in the control group. RNFL thickness was measured by optical coherence tomography in all patients. At the same time, visual acuity, intraocular pressure, and fundus were examined, and AIDS-related systemic examination (CD4(+) T lymphocyte count, HAART treatment status, and blood cytomegalovirus DNA level) was performed. The measurement data were compared by t-test, variance analysis or rank sum test. The counting data were compared by chi square test or Fisher exact probability method. Results: In the control group, the thickness of RNFL in the superior quadrant in the left and right eyes was 145 (79, 231) µm and 142 (46, 179) µm, respectively; the difference was statistically significant (Z=-2.481, P=0.013). The RNFL thickness of the diseased and healthy eyes in the MVR group was 116 (91, 138) µm and 122 (82, 192) µm, respectively, with no significant difference (Z=-0.861, P=0.389); the best corrected visual acuity was 0.0 (0.0, 0.2) and 0.0 (0.0, 0.2), respectively, with no significant difference (Z=-0.378, P=0.705). In the CMVR group, the best corrected visual acuity of the diseased and healthy eyes was (0.23±0.48) and (0.02±0.82), respectively, and the difference was statistically significant (t=-2.944, P=0.003); the RNFL thickness was 133 (61, 219) µm and 121 (69, 146), respectively, in the whole optic disc, with statistically significant difference (Z=-2.385, P=0.017), 104 (41, 374) µm and 82 (55, 121) µm, respectively, in the nasal quadrant, and 99 (14, 173) µm and 72 (36, 111) µm, respectively, in the temporal quadrant, with statistically significant difference (Z=-2.045, -2.543; P=0.041, 0.011). The RNFL thickness in the CMVR group, the MVR group, and the control group was 149 (61, 350) µm, 126 (71, 304) µm, and 113 (87, 149) µm, respectively, with statistically significant difference (H=20.908, P=0.000). Conclusions: The fundus of AIDS patients had different characteristics on optical coherence tomography. In active CMVR patients, the thickness of RNFL was generally thickened. In MVR patients, the average thickness of RNFL was thicker than that in the normal control group.(Chin J Ophthalmol, 2020, 56:258-265).

[The consistency of ultra-wide-field retinal imaging and the Superfield lens for fundus screening in HIV/AIDS patients].

Objective: To screen the retinopathy in HIV/AIDS patients with both non-mydriatic ultra-wide-field (UWF) retinal imaging and mydriatic fundus examinations with the Superfield lens and a slit lamp biomicroscope, and to evaluate the consistency of two methods and provide reference for future clinical screening work and even technological innovation (such as telemedicine screening and artificial intelligence). Methods: Cross sectional study. One hundred and fifty-eight eyes of 80 HIV-positive patients from the Ophthalmology Department of Beijing Youan Hospital were enrolled in this prospective observational study. All patients underwent comprehensive ophthalmological examination. A single image was obtained from each eye using the UWF fundus imaging system (Daytona, Optos, Dunfermline, UK), and then a dilated fundal examination with the Superfield lens was conducted by another expert. The possible type and location of the lesion with these two methods was recorded respectively. The consistency was compared using the detection rate and Kappa value. Results: Fifty-two patients (65%) had fundus changes, and 28 patients (35%) were normal. Seventy-nine eyes (50%) were normal and 79 eyes (50%) had fundus lesions. Sixty-one eyes (77.2%) had HIV-related fundus lesions, while 18 eyes (22.8%) had non-HIV-related fundus lesions. Fifty-two eyes (65.8%) suffered posterior or posterior involving lesions, and 27 eyes (34.2%) suffered isolated peripheral lesions. The detection rate of UWF retinal imaging and slit lamp biomicroscopy with the Superfield lens was 17.7% (28/158) and 18.4% (29/158) (P=1.000>0.05) for HIV-related microvascular retinopathy, 8.2% and 8.2% (13/158) (χ(2)=158.00, P=1.000) for cytomegalovirus retinitis (CMVR), 36.1% and 36.1% (57/158) (χ(2)=71.066, P=1.000) for HIV-related fundus lesions, 41.8% (66/158) and 47.5% (75/158) (χ(2)=63.514, P=0.136) for fundus lesions, 33.5% (53/158) and 31.0% (49/158) (χ(2)=108.268, P=0.388) for posterior/posterior involving lesions, and 6.4% (10/158) and 16.5% (26/158) (χ(2)=42.001, P=0.000) for isolated peripheral lesions, respectively. In general, the consistency of these two methods was moderate in detecting fundus lesions (Kappa=0.630), HIV-related fundus lesions (Kappa=0.671), HIV-related microvascular retinopathy (Kappa=0.551), and isolated peripheral lesions (Kappa=0.450). According to the fundus location, the two methods showed high consistency in the detection of posterior/posterior involving lesions (Kappa=0.826>0.75) and perfect consistency for CMVR (Kappa=1.0). Conclusions: The UWF retinal imaging system and the Superfield lens showed reasonable consistency in fundus screening in HIV/AIDS patients, especially for CMVR, or lesions in the posterior pole. (Chin J Ophthalmol, 2019, 55:763-768).

[Cytokine analysis of aqueous humor in AIDS patients].

Objective: To explore the Cytokine of aqueous humor in AIDS patients with different eye diseases. Methods: A case-control study including 38 patients who was diagnosed as acquired immunodeficiency syndrome(AIDS) at Infectious Center and Department of Ophthalmology in Beijing You'an Hospital, Capital Medical University. And 16 cases of 38 patients were cytomegalovirus retinitis (CMVR), 14 cases were HIV-related retinal disease, and 8 cases presented as normal. A series of tests were performed including vision acuity check, intraocular pressure, fundus photography, blood cell count of CD4+ T lymphocyte and the content of cytokines in aqueous humor by Luminex 200(TM) liquid chip analyzer. Intraocular pressure was analyzed by one-way ANOVA, visual acuity, CD4(+) T lymphocyte count and cytokines were analyzed by Kruskal-Wallis test, the differences between the two groups were compared by Mann-Whitney U test corrected with Bonferroni. Results: Of the 38 AIDS patients [mean age (33.7±10.0) year], 37 were males and 1 was female. The mean visual acuity of 38 patients is logMAR 1.00(0.000, 1.000). The difference of visual acuity among three groups was statistically significant (χ(2)=9.963, P=0.007). The visual acuity in CMVR group was significantly higher than that in HIV-related retinal disease group and AIDS-normal eye group. There was no statistically significant difference of intraocular pressure among three groups (F=0.830, P<0.05). The mean CD4+ T lymphocyte count was 58(4, 550)/µl and the difference was statistically significant among three groups(χ(2)=6.106, P=0.047). The CD4+ T lymphocyte count in AIDS-normal eye group was significantly higher than that in CMVR group and HIV-related retinal disease group. There was no statistically significant difference in CD4+ T lymphocyte count between HIV-related retinal disease group and CMVR group. The following cytokines in CMVR group were significantly higher than the other two groups with statistically significant differences: MIP-1b, IL-6, TNF-α, VEGF, IL-8, MCP-1, IP-10. Conclusions: In patients who was diagnosed as AIDS, cytomegalovirus retinitis would damage vision acuity seriously. The elevated cytokines' level in aqueous humor such as MIP-1b, IL-6, TNF-α, VEGF, IL-8, MCP-1, IP-10, compared with HIV-related retinal disease and AIDS-normal eye cases, may be related to the activity of Th1 cell and monocyte-macrophages system including chemokines, inflammatory factors, and vascular endothelial factors. (Chin J Ophthalmol, 2017, 53: 746-752).

[Influence of a triplex superimposed treatment on HBV replication and mutation during treating chronic hepatitis B].

OBJECTIVE: To observe and evaluate the influence of a new antiviral treatment scheme on HBV replication and mutation during treating chronic hepatitis B. METHODS: In the test group, lamivudine, IFN alpha-2b, Astragalus membranaceus were chosen as a triplex superimposed treatment scheme for treating the patients who were on the state of HBV high replication and involved in the clinical condition of chronic hepatitis B. The control group was treated with lamivudine alone. The observed parameters percentage of patients in whom HBV DNA became undetectable (serum HBV DNA<1.6 ng/L), HBeAg/anti-HBe seroconversion rate; HBV DNA serum level; HBV YMDD mutation rate and pre-C region mutation rate. RESULTS: Compared with that of the control group, HBV DNA undetectable rate of the test group increased markedly at weeks 12, 36, 48(P <0.05), HBeAg negative rate of the group increased markedly at week 36, 48(P <0.05), while anti-HBe positive rate increased only at week 48 (31.58 vs.19.23%, P <0.05). After 4 weeks of treatment, HBV DNA serum level of both the test group and the control group reduced very remarkably (P <0.01), and at week 48, reduced more significantly (P <0.001). Compared with the control group, HBV DNA serum level of the test group reduced notably at week 12 (P <0.05) and very notable at week 36 and 48(P <0.01). At week 12, the pre-C region mutation occurred in the test group, and at week 24, 36,48, the pre-C region and YMDD mutations occurred in both the test group and the control group. CONCLUSIONS: As to anti-viral treatment of chronic hepatitis B, the triplex superimposed treatment had better efficacy than lamivudine alone.