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Factors affecting the health of retinal vessels in HIV patients beginning anti-retroviral therapy.

BACKGROUND: HIV patients responding to antiretroviral therapy (ART) have a high burden of CMV and display accelerated cardiovascular change assessed systemically. We assessed the effects of HIV, ART and CMV on retinal arteries calibers (RAC), as a non-invasive measure of vasculopathy in HIV patients beginning ART.

METHODS: We analysed 79 HIV patients beginning ART in Jakarta, Indonesia, with a median (range) age of 31(19-48) years. RAC was assessed using Image J software from fundus photos of both eyes, before ART (V0) and after 3-12 months (V3-V12). CMV DNA and antibodies were assessed. Systemic vascular pathology was assessed by carotid Intima Media Thickness (cIMT). Multivariable models assessed which variables best predicted RAC values at V12.

RESULTS: HIV patients had narrower retinal arteries and higher levels of CMV antibodies than healthy controls. RAC decreased over 12 months of ART (p<0.0001). Right RAC correlated with CMV IE-1 antibody, whilst the left RAC at V3 correlated with cIMT. Multivariable models linked RAC at V12 with detectable HIV RNA at V12 and declared use of alcoholic drinks, whilst a smoking habit was protective.

CONCLUSIONS: Decreases in RAC in HIV patients responding to ART suggest progressive microvascular change distinct from changes assessed in large vessels. Correlations with CMV IE-1 antibodies suggest the decline in RAC may be accelerated by frequent reactivations of CMV. This may be a feature of severe HIV disease before ART, confirmed by associations with high baseline HIV RNA in multivariable models. Links with alcohol consumption and smoking testify to a complex pattern of modifiable risk factors.

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