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Course of cytomegalovirus retinitis in the era of highly active antiretroviral therapy.

¹ The Johns Hopkins University School of Medicine, Baltimore, MD
² The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
³ The Feinberg School of Medicine, Northwestern University, Chicago, IL
⁴ University of North Carolina School of Medicine, Chapel Hill, NC
⁵ University of California, Irvine, Irvine, CA
⁶ Weill Medical College, Cornell University, New York, NY
⁷ The University of Texas Medical Branch, Galveston, TX

Commercial Relationships: D.A. Jabs, None; M.L. Van Natta, None; J.E. Thorne, None; D.V. Weinberg, None; T.A. Meredith, None; B.D. Kuppermann, None; K. Sepkowitz, None; H.K. Li, None.

Grant Identification: NIH Grant U10 EY08052, U10 EY08057, U10 EY08067

Abstract

Purpose: To describe the course of cytomegalovirus (CMV) retinitis in patients with AIDS in the era of highly active antiretroviral therapy (HAART).

Methods: 271 patients with AIDS and CMV retinitis were followed in a multicenter, prospective, observational study every 3 months with history, eye examination, laboratory testing, and fundus photographs. Photographs were read for progression by graders at a centralized reading center. Outcome measures included retinitis progression, contralateral eye involvement among patients with unilateral disease, and retinal detachment.

Results: The rate of retinitis progression was 0.10/person–year (PY). The rate of retinitis progression decreased with increasing CD4+ T cell count; among those with CD4+ T cell counts <50 cells/µL it was 0.58/PY vs 0.02/PY among those with CD4+ T cell counts >200 cells/µL (P<0.0001). In the multivariate analysis, significant risk factors for retinitis progression included low CD4+ T cell count, positive CMV viral load, longer time from AIDS diagnosis, and low Karnofsky score. The rate of contralateral eye involvement among patients with unilateral CMV retinitis was 0.07/PY, and among those with CD4+ T cell counts <50 cells/µL it was 0.34/PY. Risk factors for contralateral eye involvement included low CD4+ T cell count and detectable CMV viral load. The rate of retinal detachment was 0.06/PY, and among those with CD4+ T cell counts <50 cells/µL it was 0.30/PY. Risk factors for a retinal detachment included low CD4+ T cell count and larger area of CMV retinitis.

Conclusions: Compared to the rates reported in the pre–HAART era for retinitis progression (3.0/PY), contralateral eye involvement (0.20/PY), and retinal detachment (0.50/PY), the rates of these events were reduced among patients in the HAART era, even among those with low CD4+ T cell counts. However, these events also occurred among patients with immune recovery and high CD4+ T cell counts. Continued ophthalmologic follow–up of patients, including those with immune recovery, is recommended in order to detect early retinitis progression.

Keywords: cytomegalovirus • retinitis • AIDS/HIV

© 2004, The Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any part of this abstract, contact the ARVO Office at arvo{at}arvo.org.