AIDS has reached epidemic proportions in the United States and throughout the world, with projections of 270,000 Americans contracting AIDS by 1991. Ocular signs are frequent and often blinding manifestations of AIDS. The role of human immune deficiency virus (HIV) infections of ocular tissues is currently ill-defined. The results of the proposed study should answer important questions regarding the pathogenesis of ocular signs in AIDS such as the relationship between HIV in retinal tissue and the small vessel vasculopathy and cotton-wool spots frequently seen in patients with AIDS and AIDS-related complex. We will determine whether HIV can be recovered from ocular tissues of asymptomatic, but HIV sero-positive individuals (who die of other causes such as trauma) or from those with AIDS-related complex or AIDS victims who do not have cytomegalovirus retinopathy or cotton-wool spots. We will determine whether optic nerves are positive for HIV in these cases and whether the route of spread of HIV to the retina is most likely via blood borne elements, contiguous via the optic nerve or both. The interactions and role of co-infections of intraocular tissues with other viruses such as herpes simplex and cytomegalovirus will be studied both in situ and in vitro utilizing ocular tissues maintained in cell culture. Localization of intraocular HIV and co-viral infections and identification of the specific cell types and lesions involved will give important insights as to potential sources of persistent HIV infection, which may influence our approach to antiviral chemotherapy. Finally, ELISA assays for HIV and hepatitis B antigens have not yet been evaluated for use with cadaveric sera and aqueous humor, which is of paramount importance for screening cornea donors. The sensitivity and specificity of these tests will be correlated with death-to-cardiac puncture time, degree of hemolysis, presence of rheumatoid factor and the use of serum separators. Production of intraocular antibodies against HIV will also be determined and correlated with the intraocular distribution of HIV. The results of these studies may lessen the chance of transmitting HIV infection via corneal transplantation.
