Changes in the natural history of cytomegalovirus retinitis following the introduction of highly active antiretroviral therapy

Deayton, Jane R; Wilson, P; Sabin, Caroline; Davey, Clare; Johnson, Margaret; Emery, Vincent C.; Griffiths, Paul

doi:10.1097/00002030-200006160-00013

Cited by 100 publications

(50 citation statements)

References 22 publications

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“…HAART has been found to be effective in restoring CD4 ϩ T-cell counts and reconstituting the immune system function in the majority of HIV patients (2,5,17,19,20,22). However, some cases of HCMV retinitis in HIV patients with high CD4 ϩ T-cell counts have been reported (7,10,15), suggesting that the HCMV-specific immune response could not be restored in…”

Section: Discussionmentioning

confidence: 99%

“…In the last few years, highly active antiretroviral therapy (HAART) has greatly reduced the incidence of human cytomegalovirus (HCMV) disease in human immunodeficiency virus (HIV)-infected patients in Western countries (5,19,20). However, at least two reasons suggest that careful monitoring of HCMV disease in HIV-infected patients is still important: first, some cases of HCMV disease in patients with relatively high CD4 ϩ T-cell counts have been reported (7,10,11,15); second, the guidelines for the discontinuation of maintenance anti-HCMV therapy are mainly based on the CD4 ϩ T-cell count (12,13,16,18,24,25,27), regardless of any possible information on the reconstitution of the HCMV-specific immune response.…”

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confidence: 99%

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Comparative Analysis of Human Cytomegalovirus-Specific CD4 ⁺ T-Cell Frequency and Lymphoproliferative Response in Human Immunodeficiency Virus-Positive Patients

Piccinini¹,

Comolli²,

Genini³

et al. 2001

Clin Diagn Lab Immunol

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Evaluation of human cytomegalovirus (HCMV)-specific T-helper immunity could contribute in optimizing anti-HCMV therapy in human immunodeficiency virus (HIV)-infected patients.Testin the lymphoproliferative response (LPR) is the standard technique used to evaluate T-helper response, but its use in the routine diagnostic laboratory setting can be problematic. The most promising new alternative technique is the determination of HCMV-specific CD4؉ T-cell frequency by flow cytometry detection of intracellular cytokine production after short-term antigen-specific activation of peripheral blood mononuclear cells. HCMV-specific LPR and CD4؉ T-cell frequency were compared in a group of 78 blood samples from 65 HIV-infected patients. The results showed concordance in 80.7% of samples. In addition, comparative analysis of sequential blood samples from 13 HIV-infected patients showed that while in about half of patients the T-helper HCMV-specific immune response remained stable during highly active antiretroviral therapy (HAART), in the other half declining levels of the HCMV-specific CD4 ؉ -mediated immune response were determined by either one or both assays. In conclusion, our data suggest that the determination of HCMV-specific CD4 ؉ T-cell frequency can be considered a valuable alternative to the LPR test for the detection of HCMV-specific T-helper response in HIV-infected patients. It could facilitate wider screening of anti-HCMV T-helper activity in HIV-infected patients, with potential benefits for clinicians in deciding strategies of discontinuation or maintenance of anti-HCMV therapy.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Comparative Analysis of Human Cytomegalovirus-Specific CD4 ⁺ T-Cell Frequency and Lymphoproliferative Response in Human Immunodeficiency Virus-Positive Patients

Piccinini¹,

Comolli²,

Genini³

et al. 2001

Clin Diagn Lab Immunol

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“…The incidence of systemic complications and opportunistic infections, including cytomegalovirus (CMV) retinitis declined dramatically compared to the rates from the pre-HAART era (1)(2)(3)(4)(5)(6)(7) . Cytomegalovirus retinitis is still one of the most common ocular manifestations and the major cause of blindness in patients with AIDS and, despite all the advances in AIDS treatment, it continues to be diagnosed (4)(5)(6)(7)(8) .…”

Section: Introductionmentioning

confidence: 99%

Clinical features and outcomes of AIDS-related cytomegalovirus retinitis in the era of highly active antiretroviral therapy

Arantes¹,

Garcia²,

Saraceno³

et al. 2010

Arq. Bras. Oftalmol.

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Clinical features and outcomes of AIDS-related cytomegalovirus retinitis in the era of highly active antiretroviral therapy Keywords: Cytomegalovirus; Retinitis; Acquired immunodeficiency syndrome; Antiretroviral therapy, highly active; AIDS-related opportunistic infections; Uveitis, posterior; Eye infections/etiology; HIV infections Purpose: To describe the features and outcomes of patients with AIDS-related cytomegalovirus retinitis after highly active antiretroviral therapy availability. Methods: Retrospective chart review of 30 consecutive patients (44 eyes) with AIDS and newly diagnosed, active AIDS-related cytomegalovirus retinitis, examined from January 2005 to December 2007. Results: The mean age was 34.8 years, 18 patients (60.0%) were male and median duration of AIDS was 90 months. Nineteen patients (63.3%) had evidence of highly active antiretroviral therapy failure and median CD4+ lymphocyte count was 12.5 cells/µl. Visual acuity at presentation was 20/40 or better in 27 eyes (61.4%). Retinitis involved Zone 1 in 13 eyes (39.5%). Despite specific anti-AIDSrelated cytomegalovirus therapy, 16 eyes (36.4%) presented relapse of retinitis and 10 eyes (22.7%) lost at least three lines of vision. When compared to highly active antiretroviral therapy responsive patients, eyes of highly active antiretroviral therapy failure patients were more likely to develop relapse of retinitis (p=0.03) and loss of at least three lines of vision (p=0.03). Conclusion: The patients in this series are essentially young men with longstanding AIDS, non-responsive to highly active antiretroviral therapy and with a similar immunological profile as noted before highly active antiretroviral therapy era. These findings have implications for the management of the disease and confirm the magnitude of rational periodic screening after diagnosis of AIDS. ABSTRACT INTRODUCTION

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“…Studies addressing CMV immune recovery were first published in 1998 24,31,44 targeting both humoral 6 and cellular responses 23 . Clinical studies followed, demonstrating a low incidence of recurrence after withdrawal of secondary prophylaxis in small samples 4,5,7,19,25,30,32,36,41,45,46 .…”

Section: Introductionmentioning

confidence: 99%

Withdrawal of maintenance therapy for cytomegalovirus retinitis in AIDS patients exhibiting immunological response to HAART

Waib

Bonon

Salles

et al. 2007

Rev. Inst. Med. trop. S. Paulo

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SUMMARYBackground: Before the introduction of highly active antiretroviral therapy (HAART), CMV retinitis was a common complication in patients with advanced HIV disease and the therapy was well established; it consisted of an induction phase to control the infection with ganciclovir, followed by a lifelong maintenance phase to avoid or delay relapses. Methods: To determine the safety of CMV maintenance therapy withdrawal in patients with immune recovery after HAART, 35 patients with treated CMV retinitis, on maintenance therapy, with CD4+ cell count greater than 100 cells/mm 3 for at least three months, but almost all patients presented these values for more than six months and viral load < 30000 copies/mL, were prospectively evaluated for the recurrence of CMV disease. Maintenance therapy was withdrawal at inclusion, and patients were monitored for at least 48 weeks by clinical and ophthalmologic evaluations, and by determination of CMV viremia markers (antigenemia-pp65), CD4+/CD8+ counts and plasma HIV RNA levels. Lymphoproliferative assays were performed on 26/35 patients. Results: From 35 patients included, only one had confirmed reactivation of CMV retinitis, at day 120 of follow-up. No patient returned positive antigenemia tests. No correlation between lymphoproliferative assays and CD4+ counts was observed. Conclusion: CMV retinitis maintenance therapy discontinuation is safe for those patients with quantitative immune recovery after HAART.

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Changes in the natural history of cytomegalovirus retinitis following the introduction of highly active antiretroviral therapy

Cited by 100 publications

References 22 publications

Comparative Analysis of Human Cytomegalovirus-Specific CD4 ⁺ T-Cell Frequency and Lymphoproliferative Response in Human Immunodeficiency Virus-Positive Patients

Comparative Analysis of Human Cytomegalovirus-Specific CD4 ⁺ T-Cell Frequency and Lymphoproliferative Response in Human Immunodeficiency Virus-Positive Patients

Clinical features and outcomes of AIDS-related cytomegalovirus retinitis in the era of highly active antiretroviral therapy

Withdrawal of maintenance therapy for cytomegalovirus retinitis in AIDS patients exhibiting immunological response to HAART

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Changes in the natural history of cytomegalovirus retinitis following the introduction of highly active antiretroviral therapy

Cited by 100 publications

References 22 publications

Comparative Analysis of Human Cytomegalovirus-Specific CD4 + T-Cell Frequency and Lymphoproliferative Response in Human Immunodeficiency Virus-Positive Patients

Comparative Analysis of Human Cytomegalovirus-Specific CD4 + T-Cell Frequency and Lymphoproliferative Response in Human Immunodeficiency Virus-Positive Patients

Clinical features and outcomes of AIDS-related cytomegalovirus retinitis in the era of highly active antiretroviral therapy

Withdrawal of maintenance therapy for cytomegalovirus retinitis in AIDS patients exhibiting immunological response to HAART

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Comparative Analysis of Human Cytomegalovirus-Specific CD4 ⁺ T-Cell Frequency and Lymphoproliferative Response in Human Immunodeficiency Virus-Positive Patients

Comparative Analysis of Human Cytomegalovirus-Specific CD4 ⁺ T-Cell Frequency and Lymphoproliferative Response in Human Immunodeficiency Virus-Positive Patients