title: Paradoxical activity of CMV retinitis in patients receiving highly active antiretroviral therapy.
abstract: OBJECTIVE
  To report two types of atypical behaviors of cytomegalovirus (CMV) retinitis in the highly active antiretroviral therapy (HAART) era, including active CMV retinitis in the presence of persistently high CD4 cell counts during HAART and CMV retinitis that has not reactivated despite persistently low CD4 cell counts.
  
  
  METHODS
  Prospective, longitudinal, observational study of a cohort of 116 patients with acquired immunodeficiency syndrome who had a history of CMV retinitis during the HAART era.
  
  
  RESULTS
  Sixty (52%) of the 116 patients with acquired immunodeficiency syndrome and CMV retinitis were HAART responders. Subsequently, HAART failed for 9 of the 60 patients with low CD4 cell counts. Of these 9 patients, 5 developed reactivation of CMV retinitis, and 4 remained free of CMV retinitis despite CD4 cell counts of <50/microL and lack of anti-CMV therapy. Paradoxically, there was a patient with a documented median CD4 cell count of 204/microL for 19 months who had newly diagnosed active CMV retinitis.
  
  
  CONCLUSIONS
  In the HAART era, CMV retinitis may remain quiescent despite extremely low CD4 cell counts, and rarely, CMV retinitis may become active in the setting of persistently high CD4 cell counts in a subset of HAART responders.
authors.affiliation: Department of Ophthalmology, University of California, San Diego, CA 92093, USA.
authors.forename: Mi-Kyoung
authors.initials: MK
authors.lastname: Song
authors.forename: Rachel D
authors.initials: RD
authors.lastname: Schrier
authors.forename: Irene L
authors.initials: IL
authors.lastname: Smith
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Plummer
authors.forename: William R
authors.initials: WR
authors.lastname: Freeman
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D015331:Cohort Studies; D017726:Cytomegalovirus Retinitis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D005500:Follow-Up Studies; D006801:Humans; D011446:Prospective Studies; D014775:Virus Activation