title: Course of cytomegalovirus retinitis in the era of highly active antiretroviral therapy: 2. Second eye involvement and retinal detachment.
abstract: 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.
authors.affiliation: Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. djabs@jhmi.edu
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
authors.forename: Mark L
authors.initials: ML
authors.lastname: Van Natta
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
authors.forename: David V
authors.initials: DV
authors.lastname: Weinberg
authors.forename: Travis A
authors.initials: TA
authors.lastname: Meredith
authors.forename: Baruch D
authors.initials: BD
authors.lastname: Kuppermann
authors.forename: Kent
authors.initials: K
authors.lastname: Sepkowitz
authors.forename: Helen K
authors.initials: HK
authors.lastname: Li
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents