Course of cytomegalovirus retinitis in the era of highly active antiretroviral therapy: 1. Retinitis progression.
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. Photographs were evaluated for relapse of the retinitis (progression) by graders at a centralized reading center.


METHODS
Retinitis progression (movement of the border of a CMV lesion > or =750 microm over a > or =750-microm front or occurrence of a new lesion one-quarter disc area or more in size).


RESULTS
The overall rate of retinitis progression was 0.10/person-year (PY); among those with CD4+ T-cell counts of <50/microl, it was 0.58/PY, compared to 0.02/PY among those with CD4+ T-cell counts of > or =200/microl (P<0.0001). In the multivariate analysis, significant risk factors for retinitis progression included a low CD4+ T-cell count, positive CMV load, longer time from AIDS diagnosis, and low Karnofsky score.


CONCLUSIONS
Compared with the rate of retinitis progression (approximately 3.0/PY) reported in the pre-HAART era, the rate of retinitis progression was reduced among patients in the HAART era, even among those with low CD4+ T-cell counts, who might be expected to behave most like patients from the pre-HAART era. However, these events also occurred among patients with high CD4+ T-cell counts and presumed immune recovery. Continued ophthalmologic follow-up of patients with immune recovery is recommended to detect early retinitis progression.
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 / Q000276:immunology / Q000503:physiopathology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D018450:Disease Progression; D016021:Epidemiologic Studies; D005260:Female; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012008:Recurrence
D000998:Antiviral Agents; D015774:Ganciclovir