The Effect of Highly Active Antiretroviral Therapy (HAART) on Accommodative-Convergence Mechanism among HIV/AIDS Patients in Northwestern Nigeria.

Background: Whilst HAART has been effective in reducing rapidly progressive retinopathies; there are other ocular manifestations of HIV which are yet to be determined, characterised and addressed. The aim of the study was to determine the effect of HAART on the Accommodative-Convergence mechanism among HIV/AIDS patients in Northwestern, Nigeria.

Methodology: This was a hospital-based cohort study; participants that met the inclusion criteria were recruited and were separated into two groups, A and B. Group A were those about to commence HAART, referred to as HAART naive, while group B was subdivided into four groups; comprising of B1: those that had been on HAART for 0 - 2½ years, group B2: >2½ - 5 years, group B3: >5 - 7½ years, and group B4: >7½ - 10 years, termed as HAART experience.

Results: There were 400 participants aged 25 – 55years with a mean age of 37.86 ± 7.5years. Most of the participants, 336 (84.0%), had an abnormal Near Point of Convergence (NPC) compared to 64 (16%) with normal NPC values. About 273 (68.2%) of the participant’s Amplitude Accommodation (AA) was within 3 to 5DS, whilst the majority of them, 305 (76.2%), had an abnormal Reading Addition.

Conclusion: The study showed that the HIV/AIDS patients on HAART exhibit an abnormally low AA, receded NPC and High presbyopic reading addition compared to age-matched HAART naïve. There was a statistically significant association between AA and HAART (p = 0.002) and HAART duration (p = 0.00), but there was no association with their CD4+ T cell levels and HAART regimen (p = 0.12, p = 0.08). There was no statistically significant association between Abnormal reading addition and HAART (p= 0.46), CD4+4 T cell levels and HAART regimen (p=0.53 and p= 0.59), but there was a statistically significant association with HAART duration (p= 0.00).

背景：尽管高效抗逆转录病毒治疗（HAART）在减少快速进展性视网膜病变方面已显成效，但HIV的其他眼部表现尚未明确、表征及解决。本研究旨在探究HAART对尼日利亚西北部HIV/AIDS患者调节集合机制（Accommodative-Convergence mechanism）的影响。

方法论：本研究为基于医院的队列研究（cohort study）；招募符合纳入标准（inclusion criteria）的参与者并分为A、B两组。A组为即将开始接受HAART治疗的患者，即未接受HAART治疗者（HAART naive）；B组细分为四个亚组：B1组为接受HAART治疗0-2.5年者，B2组为2.5年以上至5年者，B3组为5年以上至7.5年者，B4组为7.5年以上至10年者，统称为HAART治疗经验组。

结果：共纳入400名年龄在25-55岁的参与者，平均年龄为37.86±7.5岁。其中336名（84.0%）参与者存在集合近点（Near Point of Convergence，NPC）异常，64名（16%）为正常NPC。约273名（68.2%）参与者的调节幅度（Amplitude Accommodation，AA）在3-5屈光度（DS）范围内，而305名（76.2%）参与者存在阅读附加度（Reading Addition）异常。

结论：研究显示，与年龄匹配的未接受HAART治疗者相比，接受HAART治疗的HIV/AIDS患者表现出AA异常降低、NPC后退及老视阅读附加度升高。AA与HAART治疗（p=0.002）及HAART治疗时长（p=0.00）存在统计学显著相关性，但与CD4+T细胞水平（CD4+ T cell）及HAART治疗方案（HAART regimen）无相关性（p=0.12、p=0.08）。阅读附加度异常与HAART治疗（p=0.46）、CD4+T细胞水平及HAART治疗方案（p=0.53、p=0.59）无统计学显著相关性，但与HAART治疗时长存在统计学显著相关性（p=0.00）。