Occurrence of cytomegalovirus retinitis after human immunodeficiency virus immunosuppression.
OBJECTIVE
To estimate the incidence and prevalence of cytomegalovirus retinitis (CMV-R) in late-stage human immunodeficiency virus type 1 disease.


METHODS
Cohort study.


METHODS
The Multicenter AIDS Cohort Study, an ongoing 10-year study of human immunodeficiency virus type 1-infected homosexual men with semiannual visits and CD4+ cell testing.


METHODS
Three hundred sixty-seven human immunodeficiency virus type 1-infected men from the Multicenter AIDS Cohort Study who were receiving zidovudine and Pneumocystis carinii prophylaxis and who had CD4+ cell counts fall below 0.10 x 10(9)/L (100/microL).


METHODS
Kaplan-Meier-type estimates for various longitudinal quantifications of incidence and prevalence of CMV-R were obtained.


RESULTS
Among these 367 individuals, cytomegalovirus disease developed in 103, of whom 73 (71%) had ocular complications. At 4 years after the first CD4 cell count ( < 0.10 x 10(9)/L), the probability for these subjects to have (1) remained living without CMV-R was 11%, (2) died without experiencing CMV-R was 66%, (3) experienced CMV-R and be living was 6%, and (4) experienced CMV-R and died was 18%. During these 4 years, there was a 25% chance for the development of CMV-R and, on average, 0.211 person-years of CMV-R morbidity. Among those subjects in whom CMV-R developed, about 19% did have CMV-R before a CD4+ cell count of less than 0.05 x 10(9)/L ( < 50/microL) was observed, and 81% had CMV-R after the CD4+ cell count reached this threshold.


CONCLUSIONS
These estimates may be relevant to current clinical practice and help in allocating resources and planning for treatment and prophylaxis against cytomegalovirus disease.
Hoover
D R
DR
Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Md., USA.
Peng
Y
Y
Saah
A
A
Semba
R
R
Detels
R R
RR
Rinaldo
C R
CR
Phair
J P
JP
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D015331:Cohort Studies; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D017245:Foscarnet / Q000627:therapeutic use; D015774:Ganciclovir / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D015497:HIV-1; D006801:Humans; D007108:Immune Tolerance / Q000187:drug effects; D015994:Incidence; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy; D015995:Prevalence; D015996:Survival Rate; D015215:Zidovudine / Q000627:therapeutic use
D000998:Antiviral Agents; D017245:Foscarnet; D015215:Zidovudine; D015774:Ganciclovir