Mortality associated with resistant cytomegalovirus among patients with cytomegalovirus retinitis and AIDS.
OBJECTIVE
To evaluate the effect of drug-resistant cytomegalovirus (CMV) on survival among patients with CMV retinitis.


METHODS
Prospective cohort study during 1993 to 2003.


METHODS
We included 266 patients with AIDS and newly diagnosed CMV retinitis treated with either ganciclovir or foscarnet.


METHODS
Data on ganciclovir and foscarnet resistance were obtained from blood and urine specimens collected at regular, predetermined intervals. The effect of resistant CMV on mortality was evaluated with a time-dependent Cox proportional hazard model.


METHODS
Mortality.


RESULTS
The median survival of the entire cohort was 12.6 months. Analysis of risk factors for mortality demonstrated that resistant CMV was associated with an increased mortality (hazard ratio, 1.65; 95% confidence interval, 1.05-2.56; P = 0.032). Among the other parameters tested, only time since AIDS diagnosis was associated significantly with mortality, with a hazard ratio of 1.10 per year since AIDS diagnosis (P = 0.001).


CONCLUSIONS
Resistant CMV is associated with increased mortality among patients with AIDS being treated for CMV retinitis.


BACKGROUND
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Jabs
Douglas A
DA
Department of Ophthalmology, The Johns Hopkins University School of Medicine.douglas.jabs@mssm.edu
Martin
Barbara K
BK
Forman
Michael S
MS
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000302:isolation & purification / Q000502:physiology*; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D024882:Drug Resistance, Viral; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors; D019562:Viral Load
D000998:Antiviral Agents; D017245:Foscarnet; D015774:Ganciclovir