Retinal detachment risk in cytomegalovirus retinitis related to the acquired immunodeficiency syndrome.
OBJECTIVE
To compare the incidence of retinal detachment in patients treated with the ganciclovir implant compared with those treated using systemic therapy only, among 511 patients with the acquired immunodeficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis and to describe the influence of highly active antiretroviral therapy (HAART) on retinal detachment incidence.


METHODS
All patients with AIDS and CMV retinitis at 1 center were followed up prospectively from CMV retinitis diagnosis for incidence of retinal detachment. Patient- and eye-specific data regarding demographic and clinical characteristics were collected at the time of CMV retinitis diagnosis. Use of anti-CMV and antiretroviral treatments and the development of an immunologic response to HAART during follow-up were recorded.


RESULTS
No significant difference in the rate of retinal detachment was found between eyes treated with systemic therapy only and those treated with ganciclovir implants, whether used as primary therapy or subsequent to using systemic anti-CMV therapy. The use of HAART was associated with a 60% reduction in retinal detachment rate (P<.001), with the greatest benefit observed among patients who developed an immunologic response to HAART.


CONCLUSIONS
Our results suggest that there is no substantial excess risk of retinal detachment when patients with AIDS and CMV retinitis are treated with ganciclovir implants as opposed to systemic anti-CMV therapy only. However, the use of HAART in these patients appears to reduce the risk of retinal detachment substantially.
Kempen
J H
JH
Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. jkempen@jhmi.edu
Jabs
D A
DA
Dunn
J P
JP
West
S K
SK
Tonascia
J
J
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000188:drug therapy; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D017726:Cytomegalovirus Retinitis / Q000150:complications* / Q000188:drug therapy; D004343:Drug Implants; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D012163:Retinal Detachment / Q000209:etiology* / Q000517:prevention & control; D012307:Risk Factors
D019380:Anti-HIV Agents; D004343:Drug Implants; D015774:Ganciclovir