Discontinuation of anticytomegalovirus therapy in patients with HIV infection and cytomegalovirus retinitis.
BACKGROUND
Persons with cytomegalovirus (CMV) retinitis and acquired immunodeficiency syndrome (AIDS) have required lifelong anti-CMV therapy to prevent the progression of retinal disease and subsequent loss of vision.


OBJECTIVE
To determine whether patients who were taking highly active antiretroviral therapy (HAART) and who had stable CMV retinitis could safely discontinue anti-CMV therapy without reactivation of their retinitis or increase in human immunodeficiency virus (HIV) viral load.


METHODS
Prospective nonrandomized interventional trial performed from July 1997 to August 1999.


METHODS
Clinical Center of the National Institutes of Health, Bethesda, Md.


METHODS
Fourteen patients with stable CMV retinitis and HIV infection and CD4+ cell counts higher than 0.1 5 x 10(9)/L and being treated with systemic anti-CMV medications and HAART.


METHODS
Discontinuation of specific anti-CMV therapy.


METHODS
Reactivation of CMV retinitis, development of extraocular CMV infection, detection of CMV in blood and urine, HIV burden, immunologic function, quality of life, morbidity, and mortality.


RESULTS
Twelve (89.7%) of 14 patients had evidence of immune recovery uveitis before anti-CMV drugs were discontinued. No patient had reactivation of CMV retinitis or development of extraocular CMV disease during mean follow-up of 16.4 months (range, 8.3-22.0 months) without anti-CMV therapy. Human immunodeficiency viral load remained stable following cessation of anti-CMV medications. Blood and urine assays for CMV were briefly positive in 9 patients but did not predict reactivation of CMV disease. Worsening immune recovery uveitis was associated with a substantial (>3 lines) vision loss in 3 patients.


CONCLUSIONS
Maintenance anti-CMV medications were safely stopped in those patients who had stable CMV retinitis and elevated CD4+ cell counts and who were taking HAART. The study demonstrates that immune recovery following potent antiretroviral therapy is effective in controlling a major opportunistic infection, even in patients with a history of severe immunosuppression.
Whitcup
S M
SM
The Clinical Branch, National Eye Institute, National Institutes of Health, Bethesda, MD 20892-1863, USA. scottw@helix.nih.gov
Fortin
E
E
Lindblad
A S
AS
Griffiths
P
P
Metcalf
J A
JA
Robinson
M R
MR
Manischewitz
J
J
Baird
B
B
Perry
C
C
Kidd
I M
IM
Vrabec
T
T
Davey
R T
RT
Falloon
J
J
Walker
R E
RE
Kovacs
J A
JA
Lane
H C
HC
Nussenblatt
R B
RB
Smith
J
J
Masur
H
H
Polis
M A
MA
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003587:Cytomegalovirus / Q000302:isolation & purification; D017726:Cytomegalovirus Retinitis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019562:Viral Load
D019380:Anti-HIV Agents; D000998:Antiviral Agents