Incidence of cytomegalovirus (CMV) retinitis in second eyes of patients with the acquired immune deficiency syndrome and unilateral CMV retinitis.
OBJECTIVE
To evaluate the risk and risk factors for developing cytomegalovirus (CMV) retinitis in previously uninvolved second eyes among patients with unilateral CMV retinitis.


METHODS
Cohort study.


METHODS



METHODS
Single-center academic AIDS ophthalmology practice.


METHODS
Three hundred seventy-six consecutive patients with AIDS and unilateral CMV retinitis were followed from the time of CMV retinitis diagnosis for the development of second-eye retinitis.


METHODS
Demographic and clinical characteristics were noted at baseline. Use of highly active antiretroviral therapy (HAART) and immune recovery in response to HAART were noted prospectively.


METHODS
Development of CMV retinitis in a previously uninvolved eye.


RESULTS
Ninety-one percent of subjects received systemic anti-CMV treatment. Second-eye retinitis occurred in 26.1%/person-year (19.6% within the first 6 months), less than half the rate previously reported in untreated groups. Initial CD4+ T cell count >12 cells/microl, use of HAART, and initial posterior pole involvement were associated with 64%, 46%, and 41% reductions in incidence vis-à-vis comparison groups. Benefit from HAART was limited to that subset who developed immune recovery of a degree expected to restore innate control of CMV (a rise in the CD4+ T cell count by >50 cells/microl to a level >100 cells/microl).


CONCLUSIONS
The risk of second-eye retinitis is substantial in patients with unilateral CMV retinitis but appears to be reduced by anti-CMV therapy and by HAART-induced immune recovery. Patients are at highest risk when CD4+ T cell counts are very low and in the months immediately after CMV retinitis diagnosis.
Kempen
John H
JH
Department of Ophthalmology, The Johns Hopkins University School of Medicine, 550 North Broadway, Suite 700, Baltimore, MD 21205, USA. jkempen@jhmi.edu
Jabs
Douglas A
DA
Wilson
Laura A
LA
Dunn
James P
JP
West
Sheila K
SK
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology* / 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; D015331:Cohort Studies; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D007839:Functional Laterality; D006801:Humans; D015994:Incidence; D008297:Male; D008396:Maryland / Q000453:epidemiology; D012307:Risk Factors
D000998:Antiviral Agents