Antiretroviral therapy in AIDS patients with CMV disease: impact on the survival and long-term treatment outcome.
OBJECTIVE
To determine the impact of antiretroviral therapy (ART) on the long-term survival of AIDS patients with CMV disease and evaluate long-term outcomes of ART.


METHODS
A retrospective cohort study was conducted among HIV-infected patients with CMV disease in a medical school hospital during 1996-2005 and followed-up until June 2007.


RESULTS
There were 154 patients, mean age 34.5 years and 57.8% were male. Organ involvement of CMV disease included retina (94.8%), central nervous system, lungs, and gastrointestinal tract. Median CD4 cell count was 20 cells/mm(3) and 99 patients received ART. During median follow-up of 32 months (interquartile range 23-96), 29.2% of patients died. From Kaplan-Meier analysis, median survival is significantly longer in patients receiving ART (>116.2 vs. 21.6 months, log-rank test, p<0.001). From Cox's proportional hazard model, ART (HR 0.6, p<0.001) and previous opportunistic infections (HR 3.5, p=0.025) were negatively and positively associated with death, respectively. At median time of 69 months (interquartile range 34-101) in patients who received ART, 80.8% had HIV-1 RNA <50 copies/mL and median CD4 was 421 cells/mm(3). One patient had immune reconstitution syndrome at 3 months after initiation of ART and resulted in permanent vision loss.


CONCLUSIONS
ART significantly improves long-term survival of AIDS patients with CMV disease. Long-term virological and immunological outcomes are durable.
Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok 10400, Thailand. rasuy@mahidol.ac.th
Somnuek
S
Sungkanuparph
Taywin
T
Chakriyanuyok
Bodin
B
Butthum
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000401:mortality*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000150:complications / Q000401:mortality*; D005260:Female; D015497:HIV-1; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D013785:Thailand / Q000453:epidemiology
D044966:Anti-Retroviral Agents