Highly active antiretroviral therapy-related immune recovery in AIDS patients with cytomegalovirus retinitis.
OBJECTIVE
To characterize cytomegalovirus (CMV) retinitis in human immunodeficiency virus (HIV)-infected patients who demonstrate immune recovery while receiving highly active antiretroviral therapy (HAART).


METHODS
Consecutive, noncomparative case series.


METHODS
Twenty-two HIV-positive patients, from two institutions, with a history of CMV retinitis, and with elevated CD4 cell counts after HAART.


METHODS
Duration of healed CMV retinitis without anti-CMV therapy, CD4 cell count, and HIV viral load.


METHODS
Discontinuation of anti-CMV therapy after persistent elevation of CD4 cell count over 50 cell/mm3 (median, 161/mm3; range, 85-408/mm3).


RESULTS
The median period of healed CMV retinitis without anti-CMV therapy was 72 weeks (range, 33-116 weeks). Nineteen of 22 patients were still healed without anti-CMV therapy at study end. The three patients with CMV retinitis progression simultaneously had HAART, fail with CD4 cell counts of 37, 35, and 47/mm3.


CONCLUSIONS
HIV-positive patients with CMV retinitis, who demonstrate a sustained HAART-induced elevation of CD4 cell count on two consecutive counts 3 months apart and whose retinitis remains healed on anti-CMV therapy for greater than 4 months, are likely to remain healed if the anti-CMV therapy is withdrawn. It is important to monitor these patients with indirect ophthalmoscopy because HAART failure may occur and allow CMV retinitis reactivation.
Macdonald
J C
JC
Department of Ophthalmology, University of Texas Health Science Center at San Antonio, USA.
Karavellas
M P
MP
Torriani
F J
FJ
Morse
L S
LS
Smith
I L
IL
Reed
J B
JB
Freeman
W R
WR
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000502:physiology*; D003587:Cytomegalovirus / Q000235:genetics / Q000254:growth & development; D017726:Cytomegalovirus Retinitis / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D004359:Drug Therapy, Combination; D005260:Female; D015497:HIV-1 / Q000235:genetics / Q000254:growth & development; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis; D013997:Time Factors; D014775:Virus Activation / Q000187:drug effects
D000998:Antiviral Agents; D012367:RNA, Viral