Tufail, Adnan, Tufail, Adnan; (2000) Relationship between haemorheological factors and cytomegalovirus load in the blood with cytomegalovirus retinitis in patients with the Acquired Immune Deficiency Syndrome. Doctoral thesis (M.D.), University College London.

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Abstract

The purpose of the studies reported in this thesis is to evaluate factors that may help determine risk of developing active cytomegalovirus (CMV) retinitis in patients with human immunodeficiency virus infection. The studies were grouped into three broad categories, CMV load in the peripheral blood, haemorheologic measures in the peripheral blood, and measures of retinal capillary blood flow. Quantitative CMV load was studied using a hybrid capture system. The hybrid capture assay was initially compared to culture techniques and qualitative polymerase chain reaction (PCR) methods of assessing CMV, and was found to be more sensitive than culture techniques but less sensitive then the qualitative PCR assay used. A second study, an observational case series, followed two cohorts of HIV-positive and CMV antibody positive patients (10 without CMV disease, and 11 with CMV retinitis). Elevated or rising CMV DNA blood levels appeared to be associated with the development of CMV disease in patients with low CD4+ T-lymphocyte counts. In patients with CMV retinitis, rising levels appear to be associated with the development of extraocular CMV disease or reactivation of retinitis. Conversely reactivation of retinitis occurred in the absence of changes in CMV DNA blood levels. A number of haemorheologic factors that affect blood viscosity, including polymorphonuclear cell rigidity were assessed in HIV-infected patients with and without CMV retinitis. A significant increase in polymorphonuclear rigidity and lower haematocrit was found in patients with CMV retinitis. A correlation of red cell aggregation and zetacrit sedimentation ratio was found with CD4+ T-lymphocyte count. No significant differences were found in retinal capillary blood flow, as measured by scanning Laser Doppler Flowmetry, between HIV-positive patients with and without CMV retinitis. We have postulated that there is an interaction between virus load and retinal capillary blood flow that determines the risk of developing CMV retinitis.

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