Association of Age-related Macular Degeneration With Mortality in Patients With Acquired Immunodeficiency Syndrome; Role of Systemic Inflammation

Douglas A. Jabs, Mark L. Van Natta, Garrett Trang, Norman G. Jones, Jeffrey M. Milush, Ryan Cheu, Nichole Klatt, Ronald P. Danis, Peter W. Hunt

Research output: Contribution to journalArticle

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Abstract

Purpose: To evaluate the relationships among age-related macular degeneration (AMD), mortality, and biomarkers of systemic inflammation in patients with acquired immunodeficiency syndrome (AIDS). Design: Case-control study. Methods: In participants with intermediate-stage AMD at enrollment in the Longitudinal Study of the Ocular Complications of AIDS (LSOCA) and 2:1 controls matched for age and sex, cryopreserved baseline plasma specimens were assayed for biomarkers of inflammation, including high-sensitivity C-reactive protein (CRP), interleukin (IL)-6, interferon-γ inducible protein (IP)-10, soluble CD14 (sCD14), soluble CD163 (sCD163), kynurenine/tryptophan (KT) ratio, and intestinal fatty acid binding protein (I-FABP). Main outcome measure was mortality. Results: The study included 189 patients with AMD and 385 controls. In the unadjusted analysis, AMD was associated with mortality (hazard ratio [HR] 1.48; 95% confidence interval [CI] 1.02, 2.15; P =.04). In an adjusted analysis, CRP (HR 1.36; 95% CI 1.08, 1.71; P =.009), IL-6 (HR 1.45; 95% CI 1.11, 1.90; P =.006), and IP-10 (HR 1.41; 95% CI 1.08, 1.84; P =.01) were associated with mortality. In a Cox regression analysis adjusted for human immunodeficiency virus load, blood CD4+ T cell level, CRP, IL-6, and IP-10, the association of AMD with mortality was attenuated (HR 1.08; 95% CI 0.73, 1.59; P =.70), primarily by the addition of the inflammatory biomarkers. Conclusions: These data suggest that the increased mortality observed in patients with AIDS with AMD is, at least in part, a result of systemic inflammation.

Original languageEnglish (US)
Pages (from-to)230-237
Number of pages8
JournalAmerican Journal of Ophthalmology
Volume199
DOIs
StatePublished - Mar 1 2019

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Macular Degeneration
Acquired Immunodeficiency Syndrome
Inflammation
Confidence Intervals
Mortality
C-Reactive Protein
Interleukin-6
Biomarkers
Wiskott-Aldrich Syndrome
Chemokine CXCL10
Kynurenine
Fatty Acid-Binding Proteins
Tryptophan
Longitudinal Studies
Case-Control Studies
Proteins
Regression Analysis
Outcome Assessment (Health Care)
HIV
T-Lymphocytes

ASJC Scopus subject areas

  • Ophthalmology

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Association of Age-related Macular Degeneration With Mortality in Patients With Acquired Immunodeficiency Syndrome; Role of Systemic Inflammation. / Jabs, Douglas A.; Van Natta, Mark L.; Trang, Garrett; Jones, Norman G.; Milush, Jeffrey M.; Cheu, Ryan; Klatt, Nichole; Danis, Ronald P.; Hunt, Peter W.

In: American Journal of Ophthalmology, Vol. 199, 01.03.2019, p. 230-237.

Research output: Contribution to journalArticle

Jabs, Douglas A. ; Van Natta, Mark L. ; Trang, Garrett ; Jones, Norman G. ; Milush, Jeffrey M. ; Cheu, Ryan ; Klatt, Nichole ; Danis, Ronald P. ; Hunt, Peter W. / Association of Age-related Macular Degeneration With Mortality in Patients With Acquired Immunodeficiency Syndrome; Role of Systemic Inflammation. In: American Journal of Ophthalmology. 2019 ; Vol. 199. pp. 230-237.
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abstract = "Purpose: To evaluate the relationships among age-related macular degeneration (AMD), mortality, and biomarkers of systemic inflammation in patients with acquired immunodeficiency syndrome (AIDS). Design: Case-control study. Methods: In participants with intermediate-stage AMD at enrollment in the Longitudinal Study of the Ocular Complications of AIDS (LSOCA) and 2:1 controls matched for age and sex, cryopreserved baseline plasma specimens were assayed for biomarkers of inflammation, including high-sensitivity C-reactive protein (CRP), interleukin (IL)-6, interferon-γ inducible protein (IP)-10, soluble CD14 (sCD14), soluble CD163 (sCD163), kynurenine/tryptophan (KT) ratio, and intestinal fatty acid binding protein (I-FABP). Main outcome measure was mortality. Results: The study included 189 patients with AMD and 385 controls. In the unadjusted analysis, AMD was associated with mortality (hazard ratio [HR] 1.48; 95{\%} confidence interval [CI] 1.02, 2.15; P =.04). In an adjusted analysis, CRP (HR 1.36; 95{\%} CI 1.08, 1.71; P =.009), IL-6 (HR 1.45; 95{\%} CI 1.11, 1.90; P =.006), and IP-10 (HR 1.41; 95{\%} CI 1.08, 1.84; P =.01) were associated with mortality. In a Cox regression analysis adjusted for human immunodeficiency virus load, blood CD4+ T cell level, CRP, IL-6, and IP-10, the association of AMD with mortality was attenuated (HR 1.08; 95{\%} CI 0.73, 1.59; P =.70), primarily by the addition of the inflammatory biomarkers. Conclusions: These data suggest that the increased mortality observed in patients with AIDS with AMD is, at least in part, a result of systemic inflammation.",
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T1 - Association of Age-related Macular Degeneration With Mortality in Patients With Acquired Immunodeficiency Syndrome; Role of Systemic Inflammation

AU - Jabs, Douglas A.

AU - Van Natta, Mark L.

AU - Trang, Garrett

AU - Jones, Norman G.

AU - Milush, Jeffrey M.

AU - Cheu, Ryan

AU - Klatt, Nichole

AU - Danis, Ronald P.

AU - Hunt, Peter W.

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N2 - Purpose: To evaluate the relationships among age-related macular degeneration (AMD), mortality, and biomarkers of systemic inflammation in patients with acquired immunodeficiency syndrome (AIDS). Design: Case-control study. Methods: In participants with intermediate-stage AMD at enrollment in the Longitudinal Study of the Ocular Complications of AIDS (LSOCA) and 2:1 controls matched for age and sex, cryopreserved baseline plasma specimens were assayed for biomarkers of inflammation, including high-sensitivity C-reactive protein (CRP), interleukin (IL)-6, interferon-γ inducible protein (IP)-10, soluble CD14 (sCD14), soluble CD163 (sCD163), kynurenine/tryptophan (KT) ratio, and intestinal fatty acid binding protein (I-FABP). Main outcome measure was mortality. Results: The study included 189 patients with AMD and 385 controls. In the unadjusted analysis, AMD was associated with mortality (hazard ratio [HR] 1.48; 95% confidence interval [CI] 1.02, 2.15; P =.04). In an adjusted analysis, CRP (HR 1.36; 95% CI 1.08, 1.71; P =.009), IL-6 (HR 1.45; 95% CI 1.11, 1.90; P =.006), and IP-10 (HR 1.41; 95% CI 1.08, 1.84; P =.01) were associated with mortality. In a Cox regression analysis adjusted for human immunodeficiency virus load, blood CD4+ T cell level, CRP, IL-6, and IP-10, the association of AMD with mortality was attenuated (HR 1.08; 95% CI 0.73, 1.59; P =.70), primarily by the addition of the inflammatory biomarkers. Conclusions: These data suggest that the increased mortality observed in patients with AIDS with AMD is, at least in part, a result of systemic inflammation.

AB - Purpose: To evaluate the relationships among age-related macular degeneration (AMD), mortality, and biomarkers of systemic inflammation in patients with acquired immunodeficiency syndrome (AIDS). Design: Case-control study. Methods: In participants with intermediate-stage AMD at enrollment in the Longitudinal Study of the Ocular Complications of AIDS (LSOCA) and 2:1 controls matched for age and sex, cryopreserved baseline plasma specimens were assayed for biomarkers of inflammation, including high-sensitivity C-reactive protein (CRP), interleukin (IL)-6, interferon-γ inducible protein (IP)-10, soluble CD14 (sCD14), soluble CD163 (sCD163), kynurenine/tryptophan (KT) ratio, and intestinal fatty acid binding protein (I-FABP). Main outcome measure was mortality. Results: The study included 189 patients with AMD and 385 controls. In the unadjusted analysis, AMD was associated with mortality (hazard ratio [HR] 1.48; 95% confidence interval [CI] 1.02, 2.15; P =.04). In an adjusted analysis, CRP (HR 1.36; 95% CI 1.08, 1.71; P =.009), IL-6 (HR 1.45; 95% CI 1.11, 1.90; P =.006), and IP-10 (HR 1.41; 95% CI 1.08, 1.84; P =.01) were associated with mortality. In a Cox regression analysis adjusted for human immunodeficiency virus load, blood CD4+ T cell level, CRP, IL-6, and IP-10, the association of AMD with mortality was attenuated (HR 1.08; 95% CI 0.73, 1.59; P =.70), primarily by the addition of the inflammatory biomarkers. Conclusions: These data suggest that the increased mortality observed in patients with AIDS with AMD is, at least in part, a result of systemic inflammation.

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