title: Characteristics of untreated AIDS-related cytomegalovirus retinitis. I. Findings before the era of highly active antiretroviral therapy (1988 to 1994).
abstract: OBJECTIVE
  To identify factors related to variations in the appearance of untreated AIDS-related cytomegalovirus (CMV) retinitis in severely immunodeficient individuals before the availability of highly active antiretroviral therapy (HAART) and to draw inferences regarding early events in the natural history of CMV retinitis based on clinical findings.
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  We evaluated a series of 100 adult patients with AIDS and newly diagnosed CMV retinitis before the HAART era who were not being treated with specific anti-CMV therapy. Demographic factors, ophthalmic findings, and the influence of drug therapy (zidovudine, acyclovir) on lesion characteristics were evaluated. Lesion border opacity was scored using a four-point scale of severity.
  
  
  RESULTS
  Lesions could be categorized by type (fulminant/edematous or indolent/granular) in only 66% of eyes. Severe lesion border opacity (4+) was related to presence of zone 1 lesions (P = .032) and greater extent of disease (P = .004). Acyclovir use was associated with less severe opacity (P = .029) and less zone 1 involvement (P = .016). Early lesions were adjacent to vessels in 73% of eyes; the fovea was involved in 13% of eyes.
  
  
  CONCLUSIONS
  Lesion location and drug use that affects virus activity may influence the severity of lesion border opacity, a measure that may be more useful than lesion type in future clinical studies of CMV retinitis. In contrast to earlier concepts, CMV retinitis does not seem to be a fovea-sparing disease. Findings in this study can serve as a reference for investigations into possible changes in CMV retinitis since the introduction of HAART.
authors.affiliation: Ocular Inflammatory Disease Center, 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: Samuel M
authors.initials: SM
authors.lastname: Jeng
authors.forename: Fei
authors.initials: F
authors.lastname: Yu
authors.forename: David T
authors.initials: DT
authors.lastname: Goldenberg
authors.forename: Ina-Caren
authors.initials: IC
authors.lastname: Folz
authors.forename: William G
authors.initials: WG
authors.lastname: Cumberland
authors.forename: Colin A
authors.initials: CA
authors.lastname: McCannel
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Helm
authors.forename: W David
authors.initials: WD
authors.lastname: Hardy
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy; D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000627:therapeutic use; D017726:Cytomegalovirus Retinitis / Q000175:diagnosis* / Q000188:drug therapy; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D015215:Zidovudine; D000212:Acyclovir