Withdrawal of maintenance therapy for cytomegalovirus retinitis in AIDS patients exhibiting immunological response to HAART.
BACKGROUND
Before the introduction of highly active antiretroviral therapy (HAART), CMV retinitis was a common complication in patients with advanced HIV disease and the therapy was well established; it consisted of an induction phase to control the infection with ganciclovir, followed by a lifelong maintenance phase to avoid or delay relapses.


METHODS
To determine the safety of CMV maintenance therapy withdrawal in patients with immune recovery after HAART, 35 patients with treated CMV retinitis, on maintenance therapy, with CD4+ cell count greater than 100 cells/mm(3) for at least three months, but almost all patients presented these values for more than six months and viral load < 30000 copies/mL, were prospectively evaluated for the recurrence of CMV disease. Maintenance therapy was withdrawal at inclusion, and patients were monitored for at least 48 weeks by clinical and ophthalmologic evaluations, and by determination of CMV viremia markers (antigenemia-pp65), CD4+/CD8+ counts and plasma HIV RNA levels. Lymphoproliferative assays were performed on 26/35 patients.


RESULTS
From 35 patients included, only one had confirmed reactivation of CMV retinitis, at day 120 of follow-up. No patient returned positive antigenemia tests. No correlation between lymphoproliferative assays and CD4+ counts was observed.


CONCLUSIONS
CMV retinitis maintenance therapy discontinuation is safe for those patients with quantitative immune recovery after HAART.
Waib
Luis Fernando
LF
Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil.
Bonon
Sandra Helena Alves
SH
Salles
Angela Christina
AC
Benard
Gil
G
de Oliveira
Augusto César Penalva
AC
Pannuti
Claudio Sergio
CS
Pedro
Rogério de Jesus
Rde J
Costa
Sandra Cecília Botelho
SC
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D000328:Adult; D019380:Anti-HIV Agents / Q000276:immunology / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003587:Cytomegalovirus / Q000276:immunology; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019562:Viral Load; D028761:Withholding Treatment