Characteristics of Untreated AIDS-related Cytomegalovirus Retinitis. I. Findings before the Era of Highly Active Antiretroviral Therapy (1988 to 1994)

Holland, Gary N.; Vaudaux, Jean D.; Jeng, Samuel M.; Yu, Fei; Goldenberg, David T.; Folz, Ina-Caren; Cumberland, William G.; McCannel, Colin A.; Helm, Craig J.; Hardy, W. D.

doi:10.1016/j.ajo.2007.09.023

Cited by 55 publications

(56 citation statements)

References 36 publications

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“…However, lesion location may be confounded by lesion size because large lesions are more likely to encompass more than one zone. 27 The association between anterior lesion location and retinal detachment found in this study did not persist after adjusting for lesion size, suggesting that the size of a retinitis lesion is a stronger risk factor for retinal detachment than is anterior extent of the lesion, at least in this population.…”

Section: Discussionmentioning

confidence: 48%

“…In this setting with limited capacity for screening, bilateral disease is likely a marker of the duration of untreated CMV retinitis, as well as an indication of the amount of time that a patient has been severely immunocompromised. 27 Although we did not find the time between diagnosis of CMV retinitis and retinal detachment to be predictive of retinal detachment in the multivariate analysis, this variable does not capture how long the patient had CMV retinitis prior to being diagnosed. In this Thai setting, patients likely develop CMV retinitis several months before they present to the ophthalmologist.…”

Section: Discussionmentioning

confidence: 70%

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Retinal Detachment Associated With AIDS-Related Cytomegalovirus Retinitis: Risk Factors in a Resource-Limited Setting

Yen

Chen

Kunavisarut

et al. 2015

American Journal of Ophthalmology

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Purpose To determine risk factors predictive of retinal detachment in patients with cytomegalovirus (CMV) retinitis in a setting with limited access to ophthalmic care. Design Case-control study. Methods Sixty-four patients with CMV retinitis and retinal detachment were identified from the Ocular Infectious Diseases and Retina Clinics at Chiang Mai University. Three control patients with CMV retinitis but no retinal detachment were selected for each case, matched by calendar date. The medical records of each patient were reviewed, with patient-level and eye-level features recorded for the clinic visit used to match cases and controls, and also for the initial clinic visit at which CMV retinitis was diagnosed. Risk factors for retinal detachment were assessed separately for each of these time points using multivariate conditional logistic regression models that included 1 eye from each patient. Results Patients with a retinal detachment were more likely than controls to have low visual acuity (OR, 1.24 per line of worse vision on the logMAR scale; 95%CI, 1.16-1.33) and bilateral disease (OR, 2.12; 95%CI, 0.92-4.90). Features present at the time of the initial diagnosis of CMV retinitis that predicted subsequent retinal detachment included bilateral disease (OR, 2.68; 95%CI, 1.18-6.08) and lesion size (OR, 2.64 per 10% increase in lesion size; 95%CI, 1.41-4.94). Conclusion Bilateral CMV retinitis and larger lesion sizes, each of which is a marker of advanced disease, were associated with subsequent retinal detachment. Earlier detection and treatment may reduce the likelihood that patients with CMV retinitis develop a retinal detachment.

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 70%

Retinal Detachment Associated With AIDS-Related Cytomegalovirus Retinitis: Risk Factors in a Resource-Limited Setting

Yen

Chen

Kunavisarut

et al. 2015

American Journal of Ophthalmology

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“…Classically, the disease is characterized by minimal intraocular inflammation due to the deep immunodeficiency of these patients, in contrast to the severe inflammation associated with viral retinal necrosis syndromes in the immunocompetent [10 ]. Soon after the advent of HAART, enhanced inflammatory reactions, predominantly in the vitreous cavity as seen in Fig.…”

Section: Immune Recovery Uveitismentioning

confidence: 91%

Ocular immune reconstitution inflammatory syndromes

Otiti-Sengeri

Meenken

Horn

et al. 2008

Current Opinion in HIV and AIDS

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Immune recovery uveitis is the most common form of immune reconstitution inflammatory syndrome in HIV-infected patients with cytomegalovirus retinitis who are receiving highly active antiretroviral therapy. Clear clinical definitions are required for ocular immune reconstitution inflammatory syndromes to avoid misclassification of other inflammatory conditions. A multidisciplinary approach is important in the diagnosis and management of immune recovery uveitis.

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“…Patients with CMV retinitis presented a similar immunological profile as observed in the era before HAART. At that time patients had low CD4+ T-cell counts and elevated HIV viral loads (4,12) , although patients receiving HAART showed a broader range of CD4+ count, including values of more than 50 cells/µl (4) . As in other studies, most of these patients have longstanding AIDS, had received HAART and are intolerant or non responsive to this therapy (4)(5)(6) .…”

Section: Discussionmentioning

confidence: 99%

“…Patients with CD4+ lymphocytes count below 100 cells/µl and especially patients with CD4+ count 50 cells/µl or less have a proven increased risk of developing the retinitis (11) . Before HAART, CMV disease was characteristically a relapsing retinitis associated with progressive visual loss despite the repeated specific anti-CMV therapy (7,12) . As a consequence of HAART, safe discontinuation of maintenance treatment with anti-CMV medication is possible in patients who experience immune reconstitution (13)(14) .…”

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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Characteristics of Untreated AIDS-related Cytomegalovirus Retinitis. I. Findings before the Era of Highly Active Antiretroviral Therapy (1988 to 1994)

Cited by 55 publications

References 36 publications

Retinal Detachment Associated With AIDS-Related Cytomegalovirus Retinitis: Risk Factors in a Resource-Limited Setting

Retinal Detachment Associated With AIDS-Related Cytomegalovirus Retinitis: Risk Factors in a Resource-Limited Setting

Ocular immune reconstitution inflammatory syndromes

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

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