title: Visual field loss in patients with cytomegalovirus retinitis.
abstract: OBJECTIVE
  To describe visual field (VF) loss among patients with cytomegalovirus (CMV) retinitis and the risk factors for such loss.
  
  
  METHODS
  Multicenter, prospective, observational study.
  
  
  METHODS
  A total of 476 patients with AIDS and CMV retinitis, and VF data.
  
  
  METHODS
  Follow-up every 3 months with medical history, ophthalmologic examination, Goldmann visual fields, and laboratory testing.
  
  
  METHODS
  Incidence of VF loss in eyes affected with CMV retinitis and characteristics associated with such VF loss.
  
  
  RESULTS
  Over a median follow-up of 4 years (range, 0.5-9 years), the incidence rates of VF loss to 75% and 50% of normal were 0.22/eye-year (EY, 95% confidence interval [CI], 0.20-0.25) and 0.08/EY (95% CI, 0.06-0.10), respectively. The observed rates were 6- to 7-fold less than those observed rates of VF loss in the era before highly active antiretroviral therapy (HAART). Decreased CD4+ T-cell count, whether measured at enrollment or over follow-up time, was associated with increased rates of VF loss for all VF outcomes in a dose-dependent fashion. Risk factors for VF loss included lower CD4+ T-cell count, CMV lesion size >25% of the total retinal area, and active CMV retinitis after controlling for potential confounding. Highly active antiretroviral therapy use and immune recovery (CD4+ T-cell count >100 cells/μL) were associated with reduced risk of VF loss in multiple regression models. Immune recovery was statistically significantly associated with a lower risk of VF loss to 75% of normal (relative risk [RR] = 0.63; 95% CI, 0.49-0.86; P = 0.003) and to 50% of normal (RR = 0.60; 95% CI, 0.44-0.82; P = 0.001) after controlling for demographic characteristics, HIV viral load, HAART use, CMV lesion location and size, and retinitis activity.
  
  
  CONCLUSIONS
  Cytomegalovirus retinitis was associated with a substantial risk of incident VF loss, but the incidence is approximately 6-fold lower than that observed in the pre-HAART era. Those who have HAART-induced immune recovery have approximately 40% lower risk of VF loss for both outcomes after controlling for confounding.
authors.affiliation: Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. jthorne@jhmi.edu
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
authors.forename: Mark L
authors.initials: ML
authors.lastname: Van Natta
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
authors.forename: Jacque L
authors.initials: JL
authors.lastname: Duncan
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Srivastava
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D000328:Adult; D019380:Anti-HIV Agents; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D017726:Cytomegalovirus Retinitis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields
chemical_list: D019380:Anti-HIV Agents