The retinal lesions seen in AIDS patients include a non-progressive retinopathy manifested by cotton-wool patches, hemorrhages, and microvascular abnormalities, as well as a progressive infectious blinding retinitis. We plan to investigate the pathogenesis and prognostic implications of the non-progressive retinopathy and the etiology and response to treatment of the progressive infectious retinopathy by performing a prospective clinical study utilizing careful retinal examination and photography combined with new immuno-diagnostic and radiographic techniques. Patients with retinopathy will be selected from the UCSD AIDS Treatment Evaluation Unit. These patients will include those with both forms of AIDS associated retinopathy. Extensive medical and laboratory data will be provided through collaboration with co- investigators and consultants and will include neuropsychiatric data, central nervous system magnetic resonance imaging (MRI), immunologic status and results of multi-organ viral cultures for Human Immunodeficiency Virus (HIV), herpes simplex virus (HSV), cytomegalovirus (CMV), and varicella zoster virus (VZV). Patients with atypical viral retinitis will undergo vitreous biospy in order to determine the etiologic agent of the retinitis using newly developed rapid immunodiagnostic techiques for the AIDS virus (HIV), CMV, VZV, and HSV. Results of these studies will be used to guide antiviral chemotherapy and new immunoaugmentation therapies, response to which will also be assessed. Those patients who develop retinal detachment associated with an acute retinal necrosis-like syndrome will undergo repair of the detachment using silicone oil and will simultaneously undergo endoretinal biopsy in order to evaluate the etiologic nature of the retinitis and the pathophysiology of the retinal detachment. Studies on retinal tissue from biopsies and from autopsy specimens will include immunopathology and nucleic acid hybridization for HIV, HSV, CMV, VZV and Epstein-Barr (EBV) viruses, electron microscopy and complement deposition studies. Treatment of retinitis will include antiviral therapy with ganciclovir for that due to cytomegalovirus and with acyclovir for herpes zoster or varicella zoster retinitis. Newer drugs will be used as they are developed. Immunoaugmentation therapy with Beta interferon and other agents will also be evaluated. The efficacy of argon laser for prophylaxis of retinal detachment associated with ganciclovir treatment of CMV retinitis will be studied. The use of azidothymidine (AZT) and specific antiviral therapy for retinitis associated with HIV infection will be based on ongoing studies under the aegis of the AIDS Treatment Evaluation Unit at UCSD. The efficacy of various drug regimens will be assessed clinically and through viral immunologic and culture data, as well as by determining drug levels in the vitreous of those patients who undergo vitreous biopsy.
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