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

Ophthalmology. 2015 Dec;122(12):2560-7. doi: 10.1016/j.ophtha.2015.07.037. Epub 2015 Sep 6.

Abstract

Purpose: 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.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / psychology*
  • Acquired Immunodeficiency Syndrome / virology
  • Adult
  • Contrast Sensitivity / physiology
  • Cross-Sectional Studies
  • Eye Infections, Viral / psychology*
  • Eye Infections, Viral / virology
  • Female
  • HIV-1 / pathogenicity
  • Humans
  • Male
  • Middle Aged
  • Optic Nerve Diseases / psychology*
  • Optic Nerve Diseases / virology
  • Prospective Studies
  • Quality of Life / psychology*
  • Retinal Diseases / psychology*
  • Retinal Diseases / virology
  • Sickness Impact Profile
  • Surveys and Questionnaires
  • Vision Disorders / psychology*
  • Visual Acuity / physiology