title: The safety of discontinuation of maintenance therapy for cytomegalovirus (CMV) retinitis and incidence of immune recovery uveitis following potent antiretroviral therapy.
abstract: BACKGROUND
  Reconstitution of immune function during potent antiretroviral therapy can prompt discontinuation of maintenance cytomegalovirus (CMV) therapy but has also been associated with sight-threatening inflammatory conditions including immune recovery uveitis (IRU).
  
  
  METHODS
  Patients with inactive CMV retinitis and a CD4+ cell count above 100/mm3, receiving CMV therapy and stable combination antiretroviral therapy, were assigned to one of two groups based on willingness to discontinue CMV therapy.
  
  
  RESULTS
  Thirty-eight participants were enrolled: 28 discontinued anti-CMV therapy (Group 1) and 10 continued CMV treatment (Group 2). Median on-study follow-up was 16 months. One Group 1 participant who experienced an increase in plasma HIV viral load and a decline in CD4+ cell count developed confirmed progression of CMV retinitis. Progression or reactivation CMV retinitis was not observed among Group 2. IRU was present at study entry in 3 participants. Six participants in Group 1 and 3 participants in Group 2 developed IRU on-study. CMV viremia was not detected in any participants, and urinary shedding of CMV was intermittent.
  
  
  CONCLUSIONS
  Recurrence of CMV retinitis following discontinuation of anti-CMV therapy among patients with antiretroviral-induced increases in CD4+ cell count was rare. However, IRU was common in both those who maintained and discontinued anti-CMV therapy.
authors.affiliation: University of North Carolina, Chapel Hill, North Carolina 27516-7215, USA. wohl@med.unc.edu
authors.forename: D A
authors.initials: DA
authors.lastname: Wohl
authors.forename: M A
authors.initials: MA
authors.lastname: Kendall
authors.forename: S
authors.initials: S
authors.lastname: Owens
authors.forename: G
authors.initials: G
authors.lastname: Holland
authors.forename: M
authors.initials: M
authors.lastname: Nokta
authors.forename: S A
authors.initials: SA
authors.lastname: Spector
authors.forename: R
authors.initials: R
authors.lastname: Schrier
authors.forename: S
authors.initials: S
authors.lastname: Fiscus
authors.forename: M
authors.initials: M
authors.lastname: Davis
authors.forename: M A
authors.initials: MA
authors.lastname: Jacobson
authors.forename: J S
authors.initials: JS
authors.lastname: Currier
authors.forename: K
authors.initials: K
authors.lastname: Squires
authors.forename: B
authors.initials: B
authors.lastname: Alston-Smith
authors.forename: J
authors.initials: J
authors.lastname: Andersen
authors.forename: W R
authors.initials: WR
authors.lastname: Freeman
authors.forename: M
authors.initials: M
authors.lastname: Higgins
authors.forename: F J
authors.initials: FJ
authors.lastname: Torriani
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003587:Cytomegalovirus / Q000276:immunology*; D017726:Cytomegalovirus Retinitis / Q000150:complications / Q000188:drug therapy* / Q000276:immunology* / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence; D013375:Substance Withdrawal Syndrome / Q000276:immunology; D014605:Uveitis / Q000150:complications / Q000276:immunology* / Q000821:virology
chemical_list: D000998:Antiviral Agents; D012367:RNA, Viral