Risk factors for CMV retinitis among individuals with HIV and low CD4 count in northern Thailand: importance of access to healthcare.
To determine if poor access to healthcare is associated with increased cytomegalovirus (CMV) retinitis risk among patients with HIV with CD4 counts of <100 cells/μL screened in a resource-limited setting.



This is a prospective cross-sectional study. Patients with known HIV and a CD4 count of <100 cells/μL attending an HIV clinic in Chiang Mai, Thailand, completed a standardised questionnaire and underwent dilated fundus examination. Participants without CMV retinitis were invited for repeated examinations every 3 months until their CD4 count exceeded 100 cells/μL. The relationship between various potential risk factors and CMV retinitis was assessed with logistic regression.



103 study participants were enrolled. At enrolment, the mean age was 37.5 (95% CI 35.7 to 39.2) years, 61.2% (95% CI 51.6% to 70.7%) were male and the mean CD4 count was 29.5 (95% CI 25.9 to 33.1) cells/μL. 21 eyes from 16 (15.5%) participants were diagnosed with CMV retinitis. In multivariate analyses, CMV retinitis was significantly associated with lower CD4 count (OR 1.42 per 10-cell decrement, 95%CI 1.05 to 1.93), longer travel time to clinic (OR 3.85 for those with >30-min travel time, 95% CI 1.08 to 13.8) and lower income (OR 1.22 per US$50 less income, 95% CI 1.02 to 1.47).



CD4 count, low income and longer travel time to clinic were significant risk factors for CMV retinitis among patients with HIV in a resource-limited setting. These results suggest that reducing blindness from CMV retinitis should focus on increasing accessibility of screening examinations to poor and hard-to-reach patients.
Department of Internal Medicine, Nakornping Hospital, Chiang Mai, Thailand.
Prattana
P
Leenasirimakul
Francis I. Proctor Foundation, University of California, San Francisco, California Harvard Medical School, Boston, Massachusetts, USA.
Yingna
Y
Liu
Department of Ophthalmology, Nakornping Hospital, Chiang Mai, Thailand.
Choeng
C
Jirawison
Department of Internal Medicine, Nakornping Hospital, Chiang Mai, Thailand.
Nitta
N
Khienprasit
Department of Internal Medicine, Nakornping Hospital, Chiang Mai, Thailand.
Siripim
S
Kamphaengkham
Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Somsanguan
S
Ausayakhun
Francis I. Proctor Foundation, University of California, San Francisco, California.
Jenny
J
Chen
Francis I. Proctor Foundation, University of California, San Francisco, California.
Michael
M
Yen
Department of Ophthalmology and Pacific Vision Foundation, California Pacific Medical Center, San Francisco, California, USA.
David
D
Heiden
Department of Ophthalmology, Ocular Inflammatory Disease Center, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Gary N
GN
Holland
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA.
Todd P
TP
Margolis
Francis I. Proctor Foundation, University of California, San Francisco, California Department of Ophthalmology, University of California, San Francisco, California, USA.
Jeremy D
JD
Keenan
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology*; D000328:Adult; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology*; D003430:Cross-Sectional Studies; D017726:Cytomegalovirus Retinitis / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006678:HIV; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology
Infection; Public health