Regression of cytomegalovirus retinitis associated with protease-inhibitor treatment in patients with AIDS.
OBJECTIVE
To report the observation that anti-retroviral therapy that includes a protease inhibitor can induce the regression of cytomegalovirus retinitis without requiring specific anticytomegalovirus drug therapy.


METHODS
We examined the fundi of four patients with advanced acquired immunodeficiency syndrome (AIDS) who were placed on highly active antiretroviral therapy consisting of two nucleoside analogs and a protease inhibitor. The combined medications resulted in increased CD4+ T-lymphocyte counts and decreased load of human immunodeficiency virus (HIV-1). A prospective evaluation of the effect of these medications on an active cytomegalovirus retinitis lesion was conducted in one patient. Retinal lesions were documented with fundus photography.


RESULTS
None of these patients received specific anticytomegalovirus medications. The average baseline CD4+ T-lymphocyte count was 33 cells per microliter (range, 4 to 88 cells per microliter) and increased an average of 118.5 cells per microliter (range, 66 to 185 cells per microliter). Average baseline plasma HIV-1 viral loads (HIV-1-RNA copies per ml) decreased 1.46 log units (range, 0.65 to 2.93 log units). In one patient, posterior progression (border advancement toward the posterior pole) of a cytomegalovirus retinitis lesion decelerated over time and stopped. Three other patients on initial examination had areas of retinal scarring consistent with healed cytomegalovirus retinitis.


CONCLUSIONS
The addition of an HIV-1 protease inhibitor in the treatment of AIDS may lead to complete regression of cytomegalovirus retinitis without specific anticytomegalovirus medications. This effect may be related to reduced HIV-1 loads, a possible direct drug effect, an increase in CD4+ T-lymphocyte counts, or other associated changes in immune status.
Reed
J B
JB
Department of Ophthalmology, University of California, Davis, Sacramento 95816, USA.
Schwab
I R
IR
Gordon
J
J
Morse
L S
LS
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000821:virology; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count / Q000187:drug effects; D002921:Cicatrix / Q000209:etiology; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000188:drug therapy*; D005654:Fundus Oculi; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000627:therapeutic use*; D012173:Retinitis / Q000473:pathology / Q000821:virology*
D000998:Antiviral Agents; D011480:Protease Inhibitors