OCULAR MICROANGIOPATHIC SYNDROME IN PATIE NTS WITH AIDS IS ASSOCIATEDWITH ELEVATED LEVELS OF THE VASOCONSTRICTOR ENDOTHELIN-1

Objective Ocular microangiopathic syndrome is the most frequent ophtha lmic finding in patients suffering from the acquired immunodeficiency syndrome (AIDS). Ocular microvascular changes including cotton-wool sp ots are closely associated with neuroretinal and cognitive deficits in patients infected with the human immunodeficiency virus type 1 (HIV-1 ). Endothelin-1 is a recently identified cytokine with potent vasocons trictor activity which is associated with various diseases involving v ascular structures. Methods We studied 29 patients with AIDS by indire ct ophthalmoscopy and by slit lamp biomicroscopy, and endothelin-1 imm unoreactivity (IR) was measured in plasma by radioimmunoassay. Cotton- wool spots were counted as indicator of retinal microvasculopathy. Con junctival blood flow sludging in conjunctival vessels was measured by a standardized rating scale as indicator of conjunctival microvasculop athy. Parameters of immunosystemic damage were determined as covariate s. Results Endothelin-1 IR was closely associated with the number of c otton-wool spots (Spearman r = 0.53, p < 0.01) and with the extent of conjunctival blood-flow sludging (r = 0.61, p < 0.001). The level of s ignificance became stronger applying analysis of covariance with Endot helin-1 IR as dependant variable and number of cotton-wool spots (p < 0.0001) or extent of conjunctival blood-flow sludging (p < 0.0001) as independant variables. Conclusion Our data are consistent with the hyp othesis that the vasoconstrictor endothelin-1 has an important role in the pathogenesis of HIV-1-related ocular microangiopathic syndrome. A s HIV-1-related ocular microangiopathic syndrome is associated with ne uroretinal and cognitive deficits in patients with HIV-1 disease the t herapeutic use of endothelin antagonists currently under investigation should be discussed.