Monday, February 28, 2011

Losing Sight: A Glance Back at AIDS, Thirty Years into the Pandemic

Losing Sight: A Glance Back at AIDS, Thirty Years into the Pandemic

It's 2011! Spring is almost in the air. What's also in the air is the reminder that this year we celebrate thirty years, three decades, of a time of HIV and AIDS. Thirty years! Many things have changed in the way we look at the virus, the disease (or cluster of diseases) it causes, and the epidemic--the pandemic--itself. The truth is that AIDS is not only a medical disease (or problem), but also a socio-economical one, a financial one and, indeed, a cultural one. Many things have changed in terms of 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 the HAART regimens. Introduced in the mid-nineties 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 new chance to life, to an active, almost with normal life-span as the HIV-negative individuals' kind of life. There are now some twenty-something 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 the time of AIDS--life with AIDS--before the advent of HAART. Yet, that time of AIDS should never be forgotten.

It was during that time that opportunistic infections were more deadly, simply because the medications to keep those O.I.s in check were not really available. One of these O.I.s was caused by a virus called cytomegalovirus, or CMV, the number one cause of blindness in people living with AIDS. I'd like to share here an short excerpt about CMV from my book, Journeys Through Darkness. 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 ninety percent.

Hope you enjoy the read. As always, thanks for visiting,

Alina Oswald

CMV at a Glance, excerpt from Journeys Through Darkness

Flashing lights, floating spots, speckles of cotton before the eyes disturbing the 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 of an 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 an inactive, (otherwise known as “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 fifty (a healthy individual has approximately one thousand 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 affecting the retina, which swallows and inflames. As a result, the signals sent from the eye to the brain become incomplete or inaccurate, leading to blurry vision or blind spots in the vision. 
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 go to 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 in check (inactive), thus reducing the risk of more damage to the retina and, therefore, preventing more vision loss.

HAART regimens, introduced in the mid-nineties, help keep the patients' immune systems healthy enough not to be prone to CMV infections. Therefore, with the advent of HAART regimens, the cases of CMV retinitis among people living with AIDS has decreased by almost ninety percent.