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Increased Ocular Lens Density in HIV-Infected Individuals With Low Nadir CD4 Counts in South Africa: Evidence of Accelerated Aging

Pathai, Sophia MRCOphth, MSc, PhD*,†; Lawn, Stephen D. FRCP, MD†,‡; Weiss, Helen A. DPhil§; Cook, Colin FCOphth(SA); Bekker, Linda-Gail FCP, PhD; Gilbert, Clare E. FRCOphth, MSc, MD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: July 1st, 2013 - Volume 63 - Issue 3 - p 307–314
doi: 10.1097/QAI.0b013e31828ad759
Clinical Science

Background: HIV infection is thought to be associated with an increased risk of age-related morbidity and premature aging. Lens density increases with age and may function as a biomarker of aging. The relationship of lens density measurements with clinical and demographic characteristics in HIV-infected individuals in comparison with a matched population of HIV-seronegative individuals was investigated.

Methods: Case–control study of 490 adults aged greater than or equal to 30 years composed of 242 HIV-infected adults and 248 age- and sex-matched HIV-seronegative individuals. Lens density was assessed using lens densitometry (Pentacam) imaging. Measurements were divided into quartiles, and comparison of HIV status and HIV-related factors was assessed by multivariate and multinomial logistic regression.

Results: The mean age was 41.2 years in HIV-infected adults and 42.3 years in HIV-seronegative individuals (P = 0.14). Of the HIV-infected adults, 88% were receiving antiretroviral therapy (ART) (median duration, 58 months), and within this group, their median CD4 count was 468 cells per microliter and 84% had undetectable viral load. Although adjusted lens densities were similar by HIV serostatus, participants on ART and who had nadir CD4 counts less than 200 cells per microliter had a higher risk of high lens density compared with HIV-seronegative individuals (P trend = 0.04). Lens density was weakly associated with detectable HIV viremia despite ART, but not with current CD4 count.

Conclusions: HIV-infected individuals on ART with nadir CD4 counts <200 cells per microliter had increased risk of higher lens density. Lens density may represent a novel biomarker of aging, providing insight into accelerated aging trajectories in HIV infection.

*International Center for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK;

Desmond Tutu HIV Center, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa;

Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK;

§Medical Research Council Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; and

Department of Ophthalmology, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.

Correspondence to: Dr Sophia Pathai, International Center for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK (e-mail: sophia.pathai@lshtm.ac.uk).

Supported by the Wellcome Trust (090354/Z/09/Z to S. Pathai and 088590 to S. D. Lawn).

The authors have no conflicts of interest to disclose.

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Received October 15, 2012

Accepted January 30, 2013

© 2013 Lippincott Williams & Wilkins, Inc.