title: Cytomegalovirus retinitis after initiation of highly active antiretroviral therapy.
abstract: BACKGROUND
  In previous natural history studies and clinical trials, AIDS-related cytomegalovirus (CMV) retinitis has occurred primarily in patients with absolute CD4 counts of 50 cells/microL or less (0.05 x 10(9)/L) at the time of diagnosis.
  
  
  METHODS
  We report five patients identified from our clinical practices who were diagnosed with CMV retinitis while their CD4 counts were above 195 cells/microL. We also analysed, based on CD4 counts, 76 AIDS patients with newly diagnosed CMV retinitis whose CD4 lymphocyte enumerations were done in laboratories that maintained certification in a common external quality control programme.
  
  
  RESULTS
  5-24 weeks before retinitis was diagnosed, all five patients had had absolute CD4 lymphocyte counts of less than 85 cells/microL, and 4-7 weeks before diagnosis, all five patients had started taking highly active antiretroviral treatment (HAART) regimens. Only one (4%) of 27 patients enrolled in the trial between July, 1995, and February, 1996, had an absolute CD4 count of more than 50 cells/microL, and none of 27 had an absolute CD4 count of more than 100/microL on entry to the trial. However, from March, 1996 (when indinavir and ritonavir were approved by the FDA for marketing in the USA), to August, 1996, 14 (29%) of 49 patients had CD4 counts of more than 50/microL and seven (14%) of 49 had a CD4 count of more than 100 cells/microL on entry.
  
  
  CONCLUSIONS
  These findings suggest that the early immunological effects of HAART may not provide sufficient protection to prevent CMV retinitis in patients who have very low CD4 counts when therapy is started. Clinicians should note that CMV retinitis may now occur in patients who have CD4 counts of more than 100 cells/microL.
authors.affiliation: Department of Medicine, University of California, San Francisco 94110, USA. mjacobson@sfaids.ucsf.edu
authors.forename: M A
authors.initials: MA
authors.lastname: Jacobson
authors.forename: M
authors.initials: M
authors.lastname: Zegans
authors.forename: P R
authors.initials: PR
authors.lastname: Pavan
authors.forename: J J
authors.initials: JJ
authors.lastname: O'Donnell
authors.forename: F
authors.initials: F
authors.lastname: Sattler
authors.forename: N
authors.initials: N
authors.lastname: Rao
authors.forename: S
authors.initials: S
authors.lastname: Owens
authors.forename: R
authors.initials: R
authors.lastname: Pollard
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000517:prevention & control*; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000276:immunology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D017726:Cytomegalovirus Retinitis / Q000276:immunology / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006801:Humans; D019469:Indinavir / Q000008:administration & dosage; D019259:Lamivudine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019258:Saquinavir / Q000008:administration & dosage; D015215:Zidovudine / Q000008:administration & dosage
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D019259:Lamivudine; D015215:Zidovudine; D019469:Indinavir; D019258:Saquinavir