A Cytomegalovirus Retinitis Screening Program: Evaluation of Enrollment Criteria for HIV Patients in Singapore.
OBJECTIVE
Identification of optimal enrollment criteria for a CMVR screening program suitable for a resource-limited environment.


METHODS
A prospective audit was performed on newly diagnosed HIV patients referred for CMVR screening with any of the following four criteria: (1) visual symptoms, (2) low CD4(+) counts (<50 cells/µL), (3) AIDS-defining illnesses (ADI), and/or (4) opportunistic infections (OI). Odds ratios for each of the demographic factors and enrollment criteria were calculated. Sensitivities, specificities, and workload reduction for the various combinations were determined.


RESULTS
A total of 348 screening visits for 176 HIV patients were performed. While individually only ADI was statistically significant for increased CMVR risk, the combination of CD4(+) counts <50 cells/μL with either ADI or visual symptoms or all 3 criteria were also statistically significant. Two enrollment criteria, ADI and ADI with CD4(+) <50 cells/μL, demonstrated good sensitivities, specificities, and workload reduction.


CONCLUSIONS
We propose ADI and possibly CD4(+) counts <50 cells/μL as enrollment criteria for CMVR screening.
a Yong Loo Lin School of Medicine, National University of Singapore , Singapore .
Jinesh M
JM
Shah
b Dr Leo Adult & Paediatric Eye Specialist , Singapore .|c National Healthcare Group Eye Institute, Department of Ophthalmology, Tan Tock Seng Hospital , Singapore , and.
Seo W
SW
Leo
c National Healthcare Group Eye Institute, Department of Ophthalmology, Tan Tock Seng Hospital , Singapore , and.
Tian L
TL
Lee
c National Healthcare Group Eye Institute, Department of Ophthalmology, Tan Tock Seng Hospital , Singapore , and.
Xiu L
XL
Tan
c National Healthcare Group Eye Institute, Department of Ophthalmology, Tan Tock Seng Hospital , Singapore , and.|d Nobel Eye & Vision Centre , Singapore.
James C
JC
Pan
c National Healthcare Group Eye Institute, Department of Ophthalmology, Tan Tock Seng Hospital , Singapore , and.
Elizabeth P
EP
Wong
c National Healthcare Group Eye Institute, Department of Ophthalmology, Tan Tock Seng Hospital , Singapore , and.
Vernon K
VK
Yong
c National Healthcare Group Eye Institute, Department of Ophthalmology, Tan Tock Seng Hospital , Singapore , and.
Tock H
TH
Lim
c National Healthcare Group Eye Institute, Department of Ophthalmology, Tan Tock Seng Hospital , Singapore , and.
Stephen C
SC
Teoh
D000328:Adult; D054869:Clinical Audit / Q000379:methods*; D017726:Cytomegalovirus Retinitis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006678:HIV; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009017:Morbidity / Q000639:trends; D011446:Prospective Studies; D012846:Singapore / Q000453:epidemiology
AIDS-defining illness; Acquired immune deficiency syndrome; cytomegalovirus retinitis; enrollment; fundus photography; screening