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Protecting Vision : Medicine: Team treatments are helping patients with a viral disease of the eyes maintain their sight.


Scott Whiteside had been HIV-positive for more than 10 years before his vision slowly began to fade. At first, he started having trouble seeing small objects. Straight lines appeared slanted. And he began noticing a small blind spot in the center of his left eye.

"I was absolutely petrified of losing my eyesight," said the tall, 38-year-old landscape architect. "I was horrified I would never be able to work again, or worse, have to rely on someone to care for me."

When Whiteside sought treatment at UCLA's Jules Stein Eye Institute, he discovered that he had full-blown AIDS. His ravaged immune system had paved the way for development of yet another disease, cytomegalovirus retinitis, which was slowly causing his blindness. The disease attacks the retina, killing the delicate eye tissue the body is unable to regenerate.

With AIDS patients living longer with new treatment and therapies, the percentage of patients developing CMV, is expected to exceed 40%, according to a recent study in the New England Journal of Medicine.

But thanks to a unique partnership between the Jules Stein Institute and the Center for Clinical AIDS Research and Education (CARE), many patients such as Whiteside are keeping their eyesight.

Once a week, eye specialists and AIDS experts combine their expertise and hold round-table discussions on the most appropriate drug, dosage and treatment plan for each CMV retinitis patient. The doctors review about 20 such cases each week.

"Our approach of literally sitting down and working together really enhances the quality of care," said Dr. David Hardy, an associate clinical professor at the UCLA research center. The center, which receives about 450 patient visits a month, is one of 12 federally funded sites in the nation where research and experimental drug treatments for CMV retinitis is under way.

Dr. Gary N. Holland, a CMV retinitis specialist at the Stein eye Institute, said the disease is incurable but can be managed. "There is no way to get rid of the virus," he said. "We can only suppress it. Our job is to catch the disease early and keep it from spreading."

CMV is caused by a virus similar to the herpes simplex strain. It affects more than 25% of patients with AIDS, most commonly attacking the eyes, and spreading to other organs such as the liver and lungs, where it can trigger complications such as hepatitis or pneumonia.

Studies show that about half the adult population has been exposed to some form of CMV through close contact with infected people, but most healthy individuals suffer no ill-health effects from the virus, Holland said.

Current treatments for the disease include oral medications and intravenous infusions of ganciclovir and foscarnet, two highly toxic antiviral drugs. Some experimental medications, drug implants and synthetic antibodies are also being used and studied at the institute.

Before these treatments were available, AIDS patients who lived long enough to contract the disease were destined to become blind within months, Holland said.

Before Whiteside developed CMV retinitis, the West Hollywood resident had traveled to Co^te d'Ivoire on Africa's western coast to try an alternative AIDS treatment that required him to stop all his antiviral medications for seven weeks. By the time he returned to the United States, he had developed full-blown AIDS as well as CMV retinitis.

But Whiteside sought treatment before the disease totally robbed him of his vision. "Luckily, doctors caught the disease just in time," he said. "One of my greatest fears since childhood was the idea of losing my eyesight. ."

But the disease is relentless.

Kept inactive for more than a year with higher and higher doses of antiviral drugs, Whiteside's disease is once again beginning to flare up.

"It's a real struggle to keep the disease in check," Holland said. The virus becomes resistant to even the most toxic drugs over time, he said.

Whiteside's doctors are now trying to save what is left of his vision. After 17 months of fighting the disease, Whiteside has lost all but the peripheral vision in his right eye.

Whiteside recently started taking an experimental drug that his doctors hope will restrict the virus, if not reverse its progression.

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