Risk factors for CMV retinitis among individuals with HIV and low CD4 count in Northern Thailand: Importance of access to healthcare

Prattana Leenasirimakul, Yingna Liu, Choeng Jirawison, Nitta Khienprasit, Siripim Kamphaengkham, Somsanguan Ausayakhun, Jenny Chen, Michael Yen, David Heiden, Gary N. Holland, Todd P. Margolis, Jeremy D. Keenan

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Aim: To determine if poor access to healthcare is associated with increased cytomegalovirus (CMV) retinitis risk among patients with HIV with CD4 counts of <100 cells/μL screened in a resource-limited setting. Methods: This is a prospective cross-sectional study. Patients with known HIV and a CD4 count of <100 cells/μL attending an HIV clinic in Chiang Mai, Thailand, completed a standardised questionnaire and underwent dilated fundus examination. Participants without CMV retinitis were invited for repeated examinations every 3 months until their CD4 count exceeded 100 cells/μL. The relationship between various potential risk factors and CMV retinitis was assessed with logistic regression. Results: 103 study participants were enrolled. At enrolment, the mean age was 37.5 (95% CI 35.7 to 39.2) years, 61.2% (95% CI 51.6% to 70.7%) were male and the mean CD4 count was 29.5 (95% CI 25.9 to 33.1) cells/μL. 21 eyes from 16 (15.5%) participants were diagnosed with CMV retinitis. In multivariate analyses, CMV retinitis was significantly associated with lower CD4 count (OR 1.42 per 10-cell decrement, 95% CI 1.05 to 1.93), longer travel time to clinic (OR 3.85 for those with >30-min travel time, 95% CI 1.08 to 13.8) and lower income (OR 1.22 per US$50 less income, 95% CI 1.02 to 1.47). Conclusions: CD4 count, low income and longer travel time to clinic were significant risk factors for CMV retinitis among patients with HIV in a resource-limited setting. These results suggest that reducing blindness from CMV retinitis should focus on increasing accessibility of screening examinations to poor and hard-to-reach patients. ophthalmoscopy, but screening examinations are rarely done in resource-limited settings where the disease burden is highest.18 Given these realities, identifying risk factors for CMV retinitis could help public health officials, HIV doctors and ophthalmologists better understand the populations for which screening examinations would have the highest yield. In a prior study,9 we found that individuals diagnosed with CMV retinitis at a tertiary care centre in Chiang Mai, Thailand, had very advanced disease at the time of diagnosis, with many patients presenting with poor vision due to large retinitis lesions, lesions affecting the macula and optic nerve and retinal detachments. We hypothesised that the advanced state of retinitis was due to a delay in diagnosis, likely related to poor access to healthcare. We subsequently instituted a CMV retinitis screening programme in an HIV clinic in the same city, and collected information about various potential risk factors for CMV retinitis to test the hypothesis that poor access to care plays a role in the development of CMV retinitis.

Original languageEnglish (US)
Pages (from-to)1017-1021
Number of pages5
JournalBritish Journal of Ophthalmology
Volume100
Issue number8
DOIs
StatePublished - Aug 2016
Externally publishedYes

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Cytomegalovirus Retinitis
Thailand
CD4 Lymphocyte Count
HIV
Delivery of Health Care
Retinitis
Ophthalmoscopy
Retinal Detachment
Blindness
Optic Nerve
Tertiary Care Centers
Public Health

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

Cite this

Leenasirimakul, P., Liu, Y., Jirawison, C., Khienprasit, N., Kamphaengkham, S., Ausayakhun, S., ... Keenan, J. D. (2016). Risk factors for CMV retinitis among individuals with HIV and low CD4 count in Northern Thailand: Importance of access to healthcare. British Journal of Ophthalmology, 100(8), 1017-1021. https://doi.org/10.1136/bjophthalmol-2016-308556

Risk factors for CMV retinitis among individuals with HIV and low CD4 count in Northern Thailand : Importance of access to healthcare. / Leenasirimakul, Prattana; Liu, Yingna; Jirawison, Choeng; Khienprasit, Nitta; Kamphaengkham, Siripim; Ausayakhun, Somsanguan; Chen, Jenny; Yen, Michael; Heiden, David; Holland, Gary N.; Margolis, Todd P.; Keenan, Jeremy D.

In: British Journal of Ophthalmology, Vol. 100, No. 8, 08.2016, p. 1017-1021.

Research output: Contribution to journalArticle

Leenasirimakul, P, Liu, Y, Jirawison, C, Khienprasit, N, Kamphaengkham, S, Ausayakhun, S, Chen, J, Yen, M, Heiden, D, Holland, GN, Margolis, TP & Keenan, JD 2016, 'Risk factors for CMV retinitis among individuals with HIV and low CD4 count in Northern Thailand: Importance of access to healthcare', British Journal of Ophthalmology, vol. 100, no. 8, pp. 1017-1021. https://doi.org/10.1136/bjophthalmol-2016-308556
Leenasirimakul, Prattana ; Liu, Yingna ; Jirawison, Choeng ; Khienprasit, Nitta ; Kamphaengkham, Siripim ; Ausayakhun, Somsanguan ; Chen, Jenny ; Yen, Michael ; Heiden, David ; Holland, Gary N. ; Margolis, Todd P. ; Keenan, Jeremy D. / Risk factors for CMV retinitis among individuals with HIV and low CD4 count in Northern Thailand : Importance of access to healthcare. In: British Journal of Ophthalmology. 2016 ; Vol. 100, No. 8. pp. 1017-1021.
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abstract = "Aim: To determine if poor access to healthcare is associated with increased cytomegalovirus (CMV) retinitis risk among patients with HIV with CD4 counts of <100 cells/μL screened in a resource-limited setting. Methods: This is a prospective cross-sectional study. Patients with known HIV and a CD4 count of <100 cells/μL attending an HIV clinic in Chiang Mai, Thailand, completed a standardised questionnaire and underwent dilated fundus examination. Participants without CMV retinitis were invited for repeated examinations every 3 months until their CD4 count exceeded 100 cells/μL. The relationship between various potential risk factors and CMV retinitis was assessed with logistic regression. Results: 103 study participants were enrolled. At enrolment, the mean age was 37.5 (95{\%} CI 35.7 to 39.2) years, 61.2{\%} (95{\%} CI 51.6{\%} to 70.7{\%}) were male and the mean CD4 count was 29.5 (95{\%} CI 25.9 to 33.1) cells/μL. 21 eyes from 16 (15.5{\%}) participants were diagnosed with CMV retinitis. In multivariate analyses, CMV retinitis was significantly associated with lower CD4 count (OR 1.42 per 10-cell decrement, 95{\%} CI 1.05 to 1.93), longer travel time to clinic (OR 3.85 for those with >30-min travel time, 95{\%} CI 1.08 to 13.8) and lower income (OR 1.22 per US$50 less income, 95{\%} CI 1.02 to 1.47). Conclusions: CD4 count, low income and longer travel time to clinic were significant risk factors for CMV retinitis among patients with HIV in a resource-limited setting. These results suggest that reducing blindness from CMV retinitis should focus on increasing accessibility of screening examinations to poor and hard-to-reach patients. ophthalmoscopy, but screening examinations are rarely done in resource-limited settings where the disease burden is highest.18 Given these realities, identifying risk factors for CMV retinitis could help public health officials, HIV doctors and ophthalmologists better understand the populations for which screening examinations would have the highest yield. In a prior study,9 we found that individuals diagnosed with CMV retinitis at a tertiary care centre in Chiang Mai, Thailand, had very advanced disease at the time of diagnosis, with many patients presenting with poor vision due to large retinitis lesions, lesions affecting the macula and optic nerve and retinal detachments. We hypothesised that the advanced state of retinitis was due to a delay in diagnosis, likely related to poor access to healthcare. We subsequently instituted a CMV retinitis screening programme in an HIV clinic in the same city, and collected information about various potential risk factors for CMV retinitis to test the hypothesis that poor access to care plays a role in the development of CMV retinitis.",
author = "Prattana Leenasirimakul and Yingna Liu and Choeng Jirawison and Nitta Khienprasit and Siripim Kamphaengkham and Somsanguan Ausayakhun and Jenny Chen and Michael Yen and David Heiden and Holland, {Gary N.} and Margolis, {Todd P.} and Keenan, {Jeremy D.}",
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T1 - Risk factors for CMV retinitis among individuals with HIV and low CD4 count in Northern Thailand

T2 - Importance of access to healthcare

AU - Leenasirimakul, Prattana

AU - Liu, Yingna

AU - Jirawison, Choeng

AU - Khienprasit, Nitta

AU - Kamphaengkham, Siripim

AU - Ausayakhun, Somsanguan

AU - Chen, Jenny

AU - Yen, Michael

AU - Heiden, David

AU - Holland, Gary N.

AU - Margolis, Todd P.

AU - Keenan, Jeremy D.

PY - 2016/8

Y1 - 2016/8

N2 - Aim: To determine if poor access to healthcare is associated with increased cytomegalovirus (CMV) retinitis risk among patients with HIV with CD4 counts of <100 cells/μL screened in a resource-limited setting. Methods: This is a prospective cross-sectional study. Patients with known HIV and a CD4 count of <100 cells/μL attending an HIV clinic in Chiang Mai, Thailand, completed a standardised questionnaire and underwent dilated fundus examination. Participants without CMV retinitis were invited for repeated examinations every 3 months until their CD4 count exceeded 100 cells/μL. The relationship between various potential risk factors and CMV retinitis was assessed with logistic regression. Results: 103 study participants were enrolled. At enrolment, the mean age was 37.5 (95% CI 35.7 to 39.2) years, 61.2% (95% CI 51.6% to 70.7%) were male and the mean CD4 count was 29.5 (95% CI 25.9 to 33.1) cells/μL. 21 eyes from 16 (15.5%) participants were diagnosed with CMV retinitis. In multivariate analyses, CMV retinitis was significantly associated with lower CD4 count (OR 1.42 per 10-cell decrement, 95% CI 1.05 to 1.93), longer travel time to clinic (OR 3.85 for those with >30-min travel time, 95% CI 1.08 to 13.8) and lower income (OR 1.22 per US$50 less income, 95% CI 1.02 to 1.47). Conclusions: CD4 count, low income and longer travel time to clinic were significant risk factors for CMV retinitis among patients with HIV in a resource-limited setting. These results suggest that reducing blindness from CMV retinitis should focus on increasing accessibility of screening examinations to poor and hard-to-reach patients. ophthalmoscopy, but screening examinations are rarely done in resource-limited settings where the disease burden is highest.18 Given these realities, identifying risk factors for CMV retinitis could help public health officials, HIV doctors and ophthalmologists better understand the populations for which screening examinations would have the highest yield. In a prior study,9 we found that individuals diagnosed with CMV retinitis at a tertiary care centre in Chiang Mai, Thailand, had very advanced disease at the time of diagnosis, with many patients presenting with poor vision due to large retinitis lesions, lesions affecting the macula and optic nerve and retinal detachments. We hypothesised that the advanced state of retinitis was due to a delay in diagnosis, likely related to poor access to healthcare. We subsequently instituted a CMV retinitis screening programme in an HIV clinic in the same city, and collected information about various potential risk factors for CMV retinitis to test the hypothesis that poor access to care plays a role in the development of CMV retinitis.

AB - Aim: To determine if poor access to healthcare is associated with increased cytomegalovirus (CMV) retinitis risk among patients with HIV with CD4 counts of <100 cells/μL screened in a resource-limited setting. Methods: This is a prospective cross-sectional study. Patients with known HIV and a CD4 count of <100 cells/μL attending an HIV clinic in Chiang Mai, Thailand, completed a standardised questionnaire and underwent dilated fundus examination. Participants without CMV retinitis were invited for repeated examinations every 3 months until their CD4 count exceeded 100 cells/μL. The relationship between various potential risk factors and CMV retinitis was assessed with logistic regression. Results: 103 study participants were enrolled. At enrolment, the mean age was 37.5 (95% CI 35.7 to 39.2) years, 61.2% (95% CI 51.6% to 70.7%) were male and the mean CD4 count was 29.5 (95% CI 25.9 to 33.1) cells/μL. 21 eyes from 16 (15.5%) participants were diagnosed with CMV retinitis. In multivariate analyses, CMV retinitis was significantly associated with lower CD4 count (OR 1.42 per 10-cell decrement, 95% CI 1.05 to 1.93), longer travel time to clinic (OR 3.85 for those with >30-min travel time, 95% CI 1.08 to 13.8) and lower income (OR 1.22 per US$50 less income, 95% CI 1.02 to 1.47). Conclusions: CD4 count, low income and longer travel time to clinic were significant risk factors for CMV retinitis among patients with HIV in a resource-limited setting. These results suggest that reducing blindness from CMV retinitis should focus on increasing accessibility of screening examinations to poor and hard-to-reach patients. ophthalmoscopy, but screening examinations are rarely done in resource-limited settings where the disease burden is highest.18 Given these realities, identifying risk factors for CMV retinitis could help public health officials, HIV doctors and ophthalmologists better understand the populations for which screening examinations would have the highest yield. In a prior study,9 we found that individuals diagnosed with CMV retinitis at a tertiary care centre in Chiang Mai, Thailand, had very advanced disease at the time of diagnosis, with many patients presenting with poor vision due to large retinitis lesions, lesions affecting the macula and optic nerve and retinal detachments. We hypothesised that the advanced state of retinitis was due to a delay in diagnosis, likely related to poor access to healthcare. We subsequently instituted a CMV retinitis screening programme in an HIV clinic in the same city, and collected information about various potential risk factors for CMV retinitis to test the hypothesis that poor access to care plays a role in the development of CMV retinitis.

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