title: Long-term Outcomes of Cytomegalovirus Retinitis in the Era of Modern Antiretroviral Therapy: Results from a United States Cohort.
abstract: OBJECTIVE
  To describe the long-term outcomes of patients with cytomegalovirus (CMV) retinitis and AIDS in the modern era of combination antiretroviral therapy.
  
  
  METHODS
  Prospective, observational cohort study.
  
  
  METHODS
  Patients with AIDS and CMV retinitis.
  
  
  METHODS
  Immune recovery, defined as a CD4+ T-cell count >100 cells/μl for ≥3 months.
  
  
  METHODS
  Mortality, visual impairment (visual acuity <20/40), and blindness (visual acuity ≤20/200) on logarithmic visual acuity charts and loss of visual field on quantitative Goldmann perimetry.
  
  
  RESULTS
  Patients without immune recovery had a mortality of 44.4/100 person-years (PYs) and a median survival of 13.5 months after the diagnosis of CMV retinitis, whereas those with immune recovery had a mortality of 2.7/100 PYs (P < 0.001) and an estimated median survival of 27.0 years after the diagnosis of CMV retinitis. The rates of bilateral visual impairment and blindness were 0.9 and 0.4/100 PYs, respectively, and were similar between those with and without immune recovery. Among those with immune recovery, the rate of visual field loss was approximately 1% of the normal field per year, whereas among those without immune recovery it was approximately 7% of the normal field per year.
  
  
  CONCLUSIONS
  Among persons with CMV retinitis and AIDS, if there is immune recovery, long-term survival is likely, whereas if there is no immune recovery, the mortality rate is substantial. Although higher than the rates in the population not infected by human immunodeficiency virus, the rates of bilateral visual impairment and blindness are low, especially when compared with rates in the era before modern antiretroviral therapy.
authors.affiliation: Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Center for Clinical Trials, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: douglas.jabs@mssm.edu.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
authors.affiliation: Center for Clinical Trials, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Alka
authors.initials: A
authors.lastname: Ahuja
authors.affiliation: Center for Clinical Trials, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Van Natta
authors.affiliation: Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Alice T
authors.initials: AT
authors.lastname: Lyon
authors.affiliation: Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Steven
authors.initials: S
authors.lastname: Yeh
authors.affiliation: Department of Ophthalmology, University of Wisconsin, Madison, Wisconsin.
authors.forename: Ronald
authors.initials: R
authors.lastname: Danis
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001766:Blindness / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data
chemical_list: D000998:Antiviral Agents