Losing sight: A glance back at AIDS, thirty years into the pandemic

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Aids RibbonHealth News

It’s 2011!

Spring is in the air. What’s also in the air is the specter that this year we will celebrate thirty years of the planet’s time with HIV and AIDS. Thirty years! Many things have changed in the way we look at the virus, the disease it causes, and the pandemic itself. The truth is that AIDS is not only a medical disease (or problem), but also a socioeconomical one, a financial one and, indeed, a cultural one. 

Many things have changed about AIDS–the face of AIDS, of the disease itself, and how we perceive it–and yet many things have stayed the same.

One thing that has revolutionized AIDS, in a way, was the advent of HAART regimens. Introduced in the mid-1990s by Dr. Ho, these medications have turned patients lives around, having the so-called “Lazarus effect” on people living with HIV/AIDS, giving patients a second chance at an active, productive life. There are now twenty-some kinds of life-saving medications available to patients, with more, hopefully, to be made available soon. That’s why it is sometimes easy to forget life with AIDS before the advent of HAART. But that piece of our history should never be forgotten.

HIV FlashIt was during that time that opportunistic infections were more deadly, simply because the medications to keep those infections in check were not readily available. One of these OIs was caused by a virus called cytomegalovirus, or CMV, the No. 1 cause of blindness in people living with AIDS. Thanks to today’s HAART regimens, the powerful medications that keep a person’s immune system strong enough and above the level that can trigger CMV activation, the number of CMV-retinitis cases in AIDS patients has decreased by about 90 percent.

What exactly is CMV retinitis? Flashing lights, floating spots, cottony specks disturbing sight, making it hazy and blurry as if you’re looking through a screen, may or may not be early signs of blindness. These symptoms may be the first signs the eye disease called CMV retinitis.

Retinitis means infection of the retina, the thin layer of light-sensitive tissue lining the back of the eyeball. The function of the retina is to convert the optical image we see with our eyes into electrical impulses that are further sent through the optical nerve to the brain. In the case of retinitis, even if the infection is cured, scars may remain on the retina. If left untreated, retinitis can lead to partial or total blindness.

Viral retinitis (caused by a virus) is most frequent in people with weakened immune systems, like HIV/AIDS patients or cancer patients (chemotherapy treatments can weaken immunity, making the patients prone to viral retinitis). There are three viruses that are commonly responsible for viral retinitis:

  • Herpes simplex virus, which causes cold sores 
  • Varicella zoster virus (HZV or Herpes Zoster Virus), which causes chicken pox
  • Cytomegalovirus retinitis, which causes total or partial blindness.

Cytomegalovirus is a kind of herpes virus that once inside the human body, it stays there for life. The virus is transmitted through bodily fluids like saliva, blood, urine, semen and breast milk, and lives peacefully in the healthy human body in a dormant state, not causing disease. Most people get exposed to CMV, especially with age, without being aware that they have been infected.

When the immune system weakens, CMV can become active. For example, in a person with AIDS, when the T cell count dips below 50 (a healthy individual has approximately 1,000 T cells measured per unit of blood), CMV becomes active and can attack different parts of the body, causing serious damage. The virus can cause CMV retinitis in the eye or CMV pneumonia in the lungs and it can also spread to the esophagus, stomach, and bowels.

In AIDS patients, CMV most commonly affects the eye, causing CMV retinitis, an infection that inflames the retina. As a result, the signals sent from the eye to the brain become incomplete or inaccurate, leading to blurry vision or blind spots. 

In some cases, people with CMV retinitis do not have any symptoms of the disease, sometimes even while they’re on the verge of losing their sight. That’s why it is advisable for people with very low T cell counts to visit an eye specialist for regular examinations and for a special test that checks for CMV in the eyes. Early lesions would look like small yellow-white patches with a grainy appearance, often accompanied by bleeding.

There are three standard medications used to treat CMV retinitis: ganciclovir, foscarnet, and cidofovir. CMV medications can be administered as intravenous (ganciclovir alone or in combination with foscarnet), intravitreal (injected into the vitreal fluid of the eye), as intraocular implants (surgically implanted into the eye to gradually release the drug), and also as oral medication. Oral medication is used for maintenance or as prophylaxis, to keep the CMV inactive), thus reducing the risk of more damage to the retina and, therefore, preventing more vision loss.

Author Alina Oswald is a freelance writer and photographer, and the author of Journeys Through Darkness and Vampire Fantasies. On the Web at http://www.alina-arts.com/.

 

Aids RibbonHealth News

It’s 2011!

Spring is in the air. What’s also in the air is the specter that this year we will celebrate thirty years of the planet’s time with HIV and AIDS. Thirty years! Many things have changed in the way we look at the virus, the disease it causes, and the pandemic itself. The truth is that AIDS is not only a medical disease (or problem), but also a socioeconomical one, a financial one and, indeed, a cultural one.