Risk of developing cytomegalovirus retinitis in persons infected with the human immunodeficiency virus.
This study examines the risk of developing cytomegalovirus (CMV) retinitis as a function of the duration and degree of CD4+ lymphocyte depletion. A retrospective analysis of 135 persons infected with the human immunodeficiency virus (HIV) was performed. Kaplan-Meier estimates for the percentage of patients developing CMV retinitis during the 27-month study period were calculated. Twenty-six patients were diagnosed as having CMV retinitis. In 14 of these patients, T cell phenotyping was done within the 3 months preceding diagnosis. The mean CD4+ lymphocyte count for these patients was 15.6 cells/mm3 (range, 2-33/mm3). At 27 months, the percentage of patients developing CMV retinitis with baseline CD4+ lymphocyte counts of 0-50, 51-100, and 101-250 cells/mm3 was 41.9%, 26.3%, and 14.7%, respectively (log-rank test, p = 0.003). The odds ratio for developing CMV retinitis for those with baseline CD4+ lymphocyte counts of 0-50 cells/mm3 compared with those with CD4+ lymphocyte counts of 101-250 cells/mm3 was 4.62 (p = 0.002). Twenty-four patients had CD4+ lymphocyte counts of < or = 50 cells/mm3 for an average of 13.1 months prior to diagnosis. Twenty-two patients had an acquired immune deficiency syndrome (AIDS)-defining illness diagnosed for an average of 18.0 months prior to the onset of retinitis. CMV retinitis is most likely to develop in patients with AIDS when the CD4+ lymphocyte count is < or = 50 cells/mm3.
Northwestern University Medical School, Division of Infectious Disease, Chicago, IL 60611.
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P
Pertel
R
R
Hirschtick
J
J
Phair
J
J
Chmiel
L
L
Poggensee
R
R
Murphy
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000276:immunology; D000328:Adult; D015496:CD4-Positive T-Lymphocytes; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000453:epidemiology; D015828:Eye Infections, Viral / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012173:Retinitis / Q000150:complications* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors