title: Characteristics of untreated AIDS-related cytomegalovirus retinitis. II. Findings in the era of highly active antiretroviral therapy (1997 to 2000).
abstract: OBJECTIVE
  To describe host characteristics (use of highly active antiretroviral therapy [HAART]; CD4+ T-lymphocyte count; HIV ribonucleic acid [RNA] blood level) of people who were diagnosed with AIDS-related cytomegalovirus (CMV) retinitis after HAART became available and to investigate effects of HAART on ophthalmic findings.
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  We collected demographic, medical, laboratory, and ophthalmic data for all patients with AIDS and newly diagnosed, untreated CMV retinitis from January 1997 through December 2000 at 10 sites in Los Angeles and Orange Counties, California.
  
  
  RESULTS
  The proportions of Hispanic and African-American patients were equivalent to or greater than their prevalences in the AIDS and general populations of Los Angeles County. Most patients (n = 80; 63.5%) were known to be receiving HAART at the time of CMV retinitis diagnosis; only 22 patients (17.5%) were HAART-naïve. Median CD4+ T-lymphocyte count was 15 cells/microl and median HIV RNA blood level was 103,000 copies/ml for all patients, but in 10 patients, CMV retinitis developed despite good immunologic and virologic responses to HAART. When compared with HAART-naïve patients, HAART-failure patients with CMV retinitis had more asymptomatic disease (P = .073), better visual acuity in the better eye (P = .003), more bilateral disease (P = .007), less zone 1 involvement (P = .042), and lower lesion border opacity scores (P = .054).
  
  
  CONCLUSIONS
  Most patients with AIDS and newly diagnosed CMV retinitis in an urban setting are HAART-experienced. HAART may influence characteristics of new CMV retinitis lesions at presentation, despite laboratory evidence of treatment failure, possibly because of residual CMV-specific immunity.
authors.affiliation: Ocular Inflammatory Disease Center, the Jules Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. uveitis@jsei.ucla.edu
authors.forename: Gary N
authors.initials: GN
authors.lastname: Holland
authors.forename: Jean D
authors.initials: JD
authors.lastname: Vaudaux
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Shiramizu
authors.forename: Fei
authors.initials: F
authors.lastname: Yu
authors.forename: David T
authors.initials: DT
authors.lastname: Goldenberg
authors.forename: Anurag
authors.initials: A
authors.lastname: Gupta
authors.forename: Margrit
authors.initials: M
authors.lastname: Carlson
authors.forename: Russell W
authors.initials: RW
authors.lastname: Read
authors.forename: Roger D
authors.initials: RD
authors.lastname: Novack
authors.forename: Baruch D
authors.initials: BD
authors.lastname: Kuppermann
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D017726:Cytomegalovirus Retinitis / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D004359:Drug Therapy, Combination; D005260:Female; D006678:HIV / Q000235:genetics; D006801:Humans; D015141:Los Angeles; D008297:Male; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D014505:Urban Population; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D012367:RNA, Viral; D015215:Zidovudine; D000212:Acyclovir