Changes in the natural history of cytomegalovirus retinitis following the introduction of highly active antiretroviral therapy.
OBJECTIVE
To determine the effect of highly active antiretroviral therapy (HAART) on the natural history of cytomegalovirus (CMV) retinitis.


METHODS
Retrospective analysis of 103 consecutive patients diagnosed with CMV retinitis between 1990 and 1998.


METHODS
Specialist HIV medicine department of a London hospital.


METHODS
Incidence of CMV retinitis, time to death following diagnosis, episodes of progression, incidence of inflammatory complications. The date of first use of HAART was January 1995. Data were censored on 30 June 1998.


RESULTS
The incidence of CMV retinitis has declined dramatically following the introduction of HAART. Survival following CMV retinitis increased from a median of 0.65 years prior to 1995 to a median of 1.07 years after this date (P = 0.004). In multivariate analyses HAART was independently associated with improved survival (P = 0.02) and the association with year of diagnosis was no longer significant, suggesting that this effect is predominantly due to HAART. None of the patients receiving HAART experienced progression after 6 months of treatment. Complications of retinitis such as retinal detachment, uveitis and optic atrophy occurred in 39% of patients. The rare inflammatory complications of vitritis and cystoid macular oedema occurred only in recipients of HAART.


CONCLUSIONS
The introduction of HAART has had a major impact on the natural history of CMV retinitis with improved survival time and decreased risk of progression following diagnosis. However, immune reconstitution may be associated with inflammatory complications which can result in significant visual loss in the absence of active CMV disease.
Deayton
J R
JR
Department of Virology, Royal Free Hampstead National Health Service Trust and Royal Free and University College School of Medicine, London, UK. deayton@rfhsm.ac.uk
Wilson
P
P
Sabin
C A
CA
Davey
C C
CC
Johnson
M A
MA
Emery
V C
VC
Griffiths
P D
PD
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D017726:Cytomegalovirus Retinitis / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007249:Inflammation; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
D019380:Anti-HIV Agents