Investigation Of Infectious Route Of HIV-related Cytomegalovirus Retinitis

Aim:To investigate the source of intraocular pathogen in HIV patients with cytomegalovirus retinitis,and whether the patients suffer from intraocular multi-pathogenic infection.Methods:Investigate HIV patients hospitalized in the first affiliated hospital of Guangxi medical university,dividing them into CMVR group and non-CMVR group by clinical manifestations.Result:(1)CMVR group(10 patients,18 eyes)anterior aqueous humor,vitreous,peripheral serum CMV-DNA viral load of the three were compared with each other,the difference was statistically significant in Wilcoxon signed-rank test(P<0.01).(2)For the aqueous humor in CMVR group(10patiens,16 eyes),the CMV-DNA viral load was compared with the Wilcoxon signed-rank test between the higher load eye and the lower eye,and the difference in CMV-DNA viral load was statistically significant(P=0.018).For the vitreous humor in CMVR group(10 patiens,16 eyes),the CMV-DNA viral load was compared with the Wilcoxon signed-rank test between the higher load eye and the lower eye,and the difference in CMV-DNA viral load was statistically significant(P=0.012).(3)17 patients(27 eyes)had a negative correlation between CMV-DNA copy of anterior aqueous humor and peripheral blood CD4~+T cell count(r_s=-0.646,P=0.005).Peripheral serum CMV copy number was also negatively correlated with peripheral blood CD4~+T cell count(r_s=-0.487,P=0.048).(4)The DNA viral load of HSV 2 and EBV was not detected in the aqueous humor of all patients(17 patients,27 eyes),and the DNA load of the above non-CMV virus and toxoplasma IgM were not detected in the vitreous humor of the CMVR group(10 patients,9 eyes).Conclusion:(1)Besides hematogenous spread,CMV infect retina through other pathway.The possibility of the virus spread into eyes through unknown pathway,such as through lymphatic vessels or nerve,can’t be ignored;(2)Given the both eyes’viral load of patients in CMVR group were statistically significant,intraocular CMV in patients with bilateral CMVR come from different sources;(3)CD4~+T count can be used to estimate the risk of CMVR in HIV patients;(4)Intraocular multi-pathogenic infection is rare in HIV patients.