Relationship between Human Immunodeficiency Virus Neuroretinal Disorder and Vision-Specific Quality of Life among People with AIDS

详细信息    查看全文

• 作者：Davin C. Ashraf ; MD¹ ; K. Patrick May ; MS² ; Gary N. Holland ; MD¹ ; ^{uveitis@jsei.ucla.edu" class="auth_mail" title="E-mail the corresponding author} ; Mark L. Van Natta ; MHS² ; Albert W. Wu ; MD ; MPH² ; ³ ; Jennifer E. Thorne ; MD ; PhD⁴ ; Douglas A. Jabs ; MD ; MBA² ; ⁵ ; ⁶ ; for the Studies of the Ocular Complications of AIDS Research Group^&lowast ;
• 关键词：BCVA ; best-corrected visual acuity ; HIV ; human immunodeficiency virus ; HIV-NRD ; human immunodeficiency virus-related neuroretinal disorder ; logCS ; logarithm of contrast sensitivity ; LSOCA ; Longitudinal Study of the Ocular Complications of AIDS ; MCID ; minimum clinically important difference ; QOL ; quality of life ; SD ; standard deviation ; SEM ; standard error of measurement ; VFQ-25 ; 25-item Visual Function Questionnaire
• 刊名：Ophthalmology
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：122
• 期：12
• 页码：2560-2567
• 全文大小：696 K

文摘

Some human immunodeficiency virus (HIV)–infected individuals have evidence of optic nerve or retinal dysfunction that manifests as decreased contrast sensitivity, even with good best-corrected visual acuity (BCVA). This condition, termed HIV-related neuroretinal disorder (HIV-NRD), is a risk factor for vision impairment (BCVA <20/40), blindness (BCVA ≤20/200), and increased mortality. We investigated the effect of HIV-NRD on vision-specific quality of life (QOL).

Design

Cross-sectional analysis of data from a prospective, observational study.

Participants

Individuals from the Longitudinal Study of the Ocular Complications of AIDS cohort who completed the National Eye Institute 25-item Visual Function Questionnaire (VFQ-25), had BCVA of 20/40 or better, and had no evidence of ocular opportunistic infection or cataract.

Methods

We compared QOL by HIV-NRD status, adjusting for potential confounding variables, using multiple linear regression. Among those with HIV-NRD, we assessed the relationship between VFQ-25 and the logarithm of contrast sensitivity (logCS), using Spearman correlation. We defined a minimum clinically important difference (MCID) as 1 standard error of measurement from a well-characterized, historical population of individuals with a variety of ophthalmic disorders.

Main Outcome Measures

Subscales and composite VFQ-25 scores (0 = worst, 100 = best).

Results

A total of 813 individuals met study criteria. Those with HIV-NRD (n = 39 [4.8%]) had a lower mean composite score than those without HIV-NRD (81 vs. 89; P = 0.0002) and lower mean scores in the following subscales: near activities (77 vs. 86; P = 0.004), distance activities (85 vs. 91; P = 0.01), social functioning (89 vs. 96; P = 0.0005), mental health (75 vs. 87; P = 0.0001), dependency (81 vs. 94; P < 0.0001), driving (75 vs. 85; P = 0.02), color vision (90 vs. 97; P < 0.0001), and peripheral vision (85 vs. 91; P = 0.0496). Score differences for each of these subscales met criteria for MCID. Among those with HIV-NRD, there was a positive correlation between logCS and composite score (r = 0.36; 95% confidence interval, 0.04–0.60).

Conclusions

HIV-NRD has a statistically significant and clinically meaningful association with decreased vision-specific QOL among people with AIDS and good BCVA.