Eyeworld

EW NEWS & OPINION January 2017 21 by Liz Hillman EyeWorld Staff Writer 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 antiret- roviral 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 fash- ion and pay attention to whether 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 dis- eases in patients with HIV and AIDS. The age at which patients with AIDS were presenting with interme- diate-stage AMD was also younger than what would usually be expect- ed. "We noticed that although our cohort's average age was mid-40s, we saw the features of intermedi- ate-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 Growing body of research shows patients with HIV are at risk for age-related diseases P atients with AIDS are four times more likely to de- velop age-related macular degeneration (AMD), de- spite 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 ophthalmol- ogy and medicine, Icahn School of Medicine at Mount Sinai, New York, at the 2016 American Academy of Ophthalmology (AAO) annual meet- ing in Chicago. Dr. Jabs told EyeWorld the find- ings 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 immu- norestored 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 down- side is it takes a toll on your body." Dr. Jabs explained the phenom- enon 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 acti- vation associated with systemic in- flammation. 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 photo- graphs taken at baseline. The study included 1,825 patients with AIDS, 9.9% of whom were found to have intermediate-stage AMD. The preva- lence of AMD in these patients was Patients with HIV at increased risk for developing AMD at a younger age they see evidence of age-related diseases or not," Dr. Jabs said. Going forward, Dr. Jabs said his team is looking at potential mecha- nisms and/or biomarkers that could be correlated with AMD and accel- erated aging, specifically examining immunologic and inflammatory pathways. EW Reference 1. Jabs DA, et al. Prevalence of intermedi- ate-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 Presentation spotlight

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