Long-term follow-up of a cohort of HIV-infected patients who discontinued maintenance therapy for cytomegalovirus retinitis.
OBJECTIVE
To determine the long-term safety of discontinuation of maintenance therapy for cytomegalovirus retinitis (CMVR) and to identify predictors for relapse.


METHODS
This was a prospective cohort study. Patients with treated CMVR who responded to HAART were followed by ophthalmologic assessment, markers for CMV replication (blood and urine cultures, CMV antigenemia, CMV DNA by PCR), and in vitro lymphoproliferative responses to CMV and other antigens after discontinuation of CMVR maintenance therapy.


RESULTS
23 patients were followed a median of 34 (range, 5-61) months. Median CD4 count was 321/mm3 at enrollment and 395/mm3 at last follow-up. HIV RNA was <50 copies/mL in 78% of patients at enrollment and 65% at last follow-up. One CMVR reactivation occurred at 12 months at a CD4 count of 395/mm3 (21%) and HIV RNA <50 copies/mL. Urine cultures were a poor predictive marker for reactivation. Other CMV replication markers had good negative predictive value. 96% of patients had a good lymphoproliferative response to CMV antigen in vitro.


CONCLUSIONS
Maintenance therapy for CMVR can safely be discontinued in patients who have responded to HAART. Combining our results with the published literature, the risk of reactivation is estimated at 0.016 per person year of follow-up. Markers to predict relapse and the need for re-initiation of maintenance therapy are not yet identified.
Walmsley
Sharon L
SL
Department of Medicine, Toronto Hospital, University Health Network, University of Toronto, Canada. sharon.walmsley@uhn.on.ca
Raboud
Janet
J
Angel
Jonathan B
JB
Mazzulli
Tony
T
Shen
Sandy
S
Casciaro
Lidia
L
Young
Charlene D
CD
Moussa
George
G
Gough
Kevin
K
Rachlis
Anita
A
Hopkins
Jill
J
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D000328:Adult; D000956:Antigens, Viral / Q000097:blood; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000254:growth & development*; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D005260:Female; D005500:Follow-Up Studies; D006678:HIV / Q000254:growth & development*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D019562:Viral Load; D014779:Virus Replication
D000956:Antigens, Viral; D000998:Antiviral Agents