Course of cytomegalovirus retinitis in the era of highly active antiretroviral therapy: 2. Second eye involvement and retinal detachment.
OBJECTIVE
To describe the course of cytomegalovirus (CMV) retinitis in patients with AIDS in the era of highly active antiretroviral therapy (HAART).


METHODS
Multicenter, prospective, observational study.


METHODS
Two hundred seventy-one patients with AIDS and CMV retinitis.


METHODS
Follow-up every 3 months with medical history, ophthalmologic examination, laboratory testing, and fundus photographs.


METHODS
Second (contralateral) eye involvement among patients with unilateral disease and retinal detachment (RD).


RESULTS
The overall rate of second eye involvement among patients with unilateral CMV retinitis was 0.07 per person-year (PY); among those with CD4+ T-cell counts of <50/microl it was 0.34/PY, compared with 0.02/PY among those with CD4+ T-cell counts of > or =200/microl (P<0.0001). Risk factors for contralateral eye involvement included low CD4+ T-cell count and detectable CMV load. The overall rate of RD was 0.06/PY; among those with CD4+ T-cell counts of <50/microl it was 0.30/PY, compared with 0.02/PY among those with CD4+ T-cell counts of > or =200/microl (P<0.0001). Risk factors for RD included a low CD4+ T-cell count and larger area of CMV retinitis.


CONCLUSIONS
Compared with the rates reported in the pre-HAART era of second eye involvement (approximately 0.40/PY) and RD (approximately 0.50/PY), the rates of these events were reduced among patients in the HAART era. However, among patients with CD4+ T-cell counts of <50/microl, the rates were more similar to those from the pre-HAART era.
Jabs
Douglas A
DA
Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. djabs@jhmi.edu
Van Natta
Mark L
ML
Thorne
Jennifer E
JE
Weinberg
David V
DV
Meredith
Travis A
TA
Kuppermann
Baruch D
BD
Sepkowitz
Kent
K
Li
Helen K
HK
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012163:Retinal Detachment / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D012307:Risk Factors
D019380:Anti-HIV Agents