Long-lasting remission of cytomegalovirus retinitis without maintenance therapy in human immunodeficiency virus-infected patients.
Seven AIDS patients who were receiving suppressive therapy for previously diagnosed cytomegalovirus (CMV) retinitis were offered treatment with protease inhibitors (PIs). Secondary prophylaxis for CMV was discontinued after 3 months of therapy with PIs if patients had >150 CD4 cells/mm3 and a human immunodeficiency virus (HIV) load of <200 copies/mL and if they were negative for CMV as determined by qualitative CMV polymerase chain reaction (PCR). Ophthalmologic exams were done periodically. After a median follow-up of 9 months (range, 9-12), no new episodes of CMV retinitis were observed. CD4 cell counts were >150 cells/mm3 in all cases, HIV loads were <200 copies/mL, and results for qualitative CMV PCRs remained negative. These observations suggest that for selected patients with healed CMV retinitis who have immunologic and virologic evidence of a clinical response to potent combination antiretroviral therapy, temporary discontinuation of a chronic anti-CMV suppressive therapy may not result in further retinal necrosis. However, the long-term immunologic benefit of PIs and hence the safety of prolonged withdrawal of anti-CMV therapy is unknown.
Tural
C
C
Ophthalmologic Department, Germans Trias i Pujol University Hospital, Badalona, Spain.
Romeu
J
J
Sirera
G
G
Andreu
D
D
Conejero
M
M
Ruiz
S
S
Jou
A
A
Bonjoch
A
A
Ruiz
L
L
Arnó
A
A
Clotet
B
B
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology*; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003587:Cytomegalovirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D017726:Cytomegalovirus Retinitis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D017245:Foscarnet / Q000008:administration & dosage* / Q000627:therapeutic use; D015774:Ganciclovir / Q000008:administration & dosage* / Q000627:therapeutic use; D006678:HIV / Q000276:immunology / Q000302:isolation & purification; D017320:HIV Protease Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000302:isolation & purification; D012008:Recurrence; D019562:Viral Load
D019380:Anti-HIV Agents; D004279:DNA, Viral; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D017245:Foscarnet; D015774:Ganciclovir