Clinical characteristics and outcomes of cytomegalovirus retinitis in persons without human immunodeficiency virus infection.
OBJECTIVE
To describe the characteristics and outcomes of patients with cytomegalovirus (CMV) retinitis in the absence of human immunodeficiency virus (HIV) infection.


METHODS
Retrospective cohort study.


METHODS
Consecutive patients with CMV retinitis in the absence of HIV infection were identified at a university hospital. Demographic and clinical characteristics were noted at the time of CMV retinitis. Outcomes were determined retrospectively. Main outcome measures were rates of second eye involvement, vision loss, rhegmatogenous retinal detachment (RD), immune recovery uveitis, progression of retinitis, and mortality.


RESULTS
The clinical characteristics of CMV retinitis in 18 patients (30 eyes) without HIV infection diagnosed between January 1, 1984, and April 13, 2003, were similar to those of patients with HIV infection. The incidences of visual loss to the levels of 20/50 or worse and of 20/200 or worse were 17% per eye-year and 14% per eye-year, respectively. The observed incidence of RD was 3.7% per eye-year, and the mortality rate was 23% per person-year. Following reduction of immunosuppression, 10 patients (56%) who discontinued anti-CMV therapy remained free of retinitis progression. The incidence of immune recovery uveitis was 13% per person-year.


CONCLUSIONS
In our series, CMV retinitis in patients without HIV infection had a clinical course similar to that in patients with AIDS treated with highly active antiretroviral therapy (HAART), except the incidence of RD was lower for patients without AIDS. A substantial number of patients no longer required long-term anti-CMV therapy after adjustment of immunomodulatory therapy.
Kuo
Irene C
IC
Department of Ophthalmology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. ickuo@jhmi.edu
Kempen
John H
JH
Dunn
James P
JP
Vogelsang
Georgia
G
Jabs
Douglas A
DA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D017726:Cytomegalovirus Retinitis / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D018023:HIV Seronegativity; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012163:Retinal Detachment / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology; D014792:Visual Acuity
D000998:Antiviral Agents; D007166:Immunosuppressive Agents