CMV retinitis recurs after stopping treatment in virological and immunological failures of potent antiretroviral therapy

Torriani, Francesca J.; Freeman, William R.; Macdonald, Jonathan; Karavellas, Marietta P.; Durand, D; Jeffrey, Daniel; Meylan, Pascal; Schrier, Rachel

doi:10.1097/00002030-200001280-00013

Cited by 76 publications

(31 citation statements)

References 22 publications

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“…Similar to the findings of Schrier and colleagues [8,13] and of Komanduri et al [10], most patients with active CMV disease in this study did not demonstrate responses by either assay (7/7 for LP and 3/5 for CFC). By contrast, all who remained free of CMV disease while not receiving anti-CMV therapy had a positive response by each assay at least once during the 6-month observation, although many also had negative responses by 1 or both assays у1 time.…”

Section: Discussionsupporting

confidence: 90%

Cytomegalovirus (CMV)–Specific CD4⁺T Lymphocyte Immune Function in Long‐Term Survivors of AIDS‐Related CMV End‐Organ Disease Who Are Receiving Potent Antiretroviral Therapy

Jacobson¹,

Schrier²,

McCune³

et al. 2001

J INFECT DIS

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To better understand the relation of cytomegalovirus (CMV)-specific CD4+ T lymphocyte immunity and clinical outcome in AIDS-related CMV end-organ disease, 2 patient groups were prospectively studied: patients recently diagnosed with active CMV end-organ disease and survivors of CMV retinitis who had responded to highly active antiretroviral therapy and had quiescent retinitis when anti-CMV therapy was discontinued. Most patients with active CMV disease had negative CMV-specific CD4+ T lymphocyte responses at diagnosis, as measured by lymphoproliferation (7/7) or cytokine flow cytometry (3/5) assays. In contrast, all 10 subjects with quiescent retinitis and >150 absolute CD4+ T lymphocytes/microL whose anti-CMV therapy was discontinued during 6 months of follow-up had positive CMV-specific immune responses at least once by each assay. However, 6 of these 10 subjects also had negative CMV-specific immune responses > or =1 time. Such patients may be at risk for future CMV disease progression and should be closely monitored.

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Section: Discussionsupporting

confidence: 90%

Cytomegalovirus (CMV)–Specific CD4⁺T Lymphocyte Immune Function in Long‐Term Survivors of AIDS‐Related CMV End‐Organ Disease Who Are Receiving Potent Antiretroviral Therapy

Jacobson¹,

Schrier²,

McCune³

et al. 2001

J INFECT DIS

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“…CMV viral load or other markers of CMV infection (e.g., antigenemia or viral deoxyribonucleic acid [DNA] tests) are not well-standardized; their role in predicting relapse remains to be defined (117,118). Relapses have been reported rarely among patients with CD4 + T lymphocyte counts of >100-150 cells/µL (119).…”

Section: Preventing Recurrencementioning

confidence: 99%

Mycobacterium Avium in Pygmy Rabbits (Brachylagus Idahoensis): 28 Cases

Harrenstien¹,

Finnegan²,

Woodford³

et al. 2006

Journal of Zoo and Wildlife Medicine

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“…Because patients starting HAART after a diagnosis of CMV disease often experience immune reconstitution, it is now possible to consider discontinuing maintenance therapy in selected patients (8,11,50).…”

Section: Discontinuation Of CMV Retinitis Maintenance Therapymentioning

confidence: 99%

“…• Discontinuation of maintenance therapy can be considered in patients taking HAART who have had a CD4 count greater than 100 cells/µL for longer than six months (evidence grade IIB) (8,11,50). The decision to discontinue therapy should also take into account the patient's HIV viral load, the anatomical location of retinal lesions, the remaining vision in both eyes, the feasibility of regular ophthalmological follow-up and adherence and adverse events related to both HAART and anti-CMV therapy (evidence grade IIB) (11).…”

Section: Recommendationsmentioning

confidence: 99%

Canadian Consensus Guidelines for the Management of Cytomegalovirus Disease in HIV/AIDS

Lalonde¹,

Bovivin²,

Deschênes³

et al. 2004

Canadian Journal of Infectious Diseases and Medical Microbiolog

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BACKGROUND: The management of HIV-infected patients with cytomegalovirus (CMV) disease has changed significantly with the availability of highly active antiretroviral therapy (HAART).OBJECTIVES: These updated guidelines are intended to provide practical help to physicians managing HIV-positive patients with or at risk for CMV disease.METHODS: The 10 members of the Canadian CMV Disease in HIV/AIDS Consensus Group were infectious disease specialists, a primary care physician and ophthalmologists with expertise in HIV and CMV infection. Financial support by Hoffmann-La Roche Canada Ltd was unrestricted, and was limited to travel expenses and honoraria. The consensus group met in June and October 2002. Key areas to be considered were identified, and group members selected, reviewed and presented relevant recent literature for their assigned section for the group's consideration. Evidence was assessed based on established criteria, which were expert opinions of the members. Draft documents were circulated to the entire group and modified until consensus was reached. The final guidelines represent the group's consensus agreement. The guidelines were approved by the Canadian Infectious Disease Society.RESULTS AND CONCLUSIONS: The guidelines address symptom monitoring, screening for early detection and prevention, and treatment using oral, intravenous and intraocular anti-CMV therapies in conjunction with HAART.

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CMV retinitis recurs after stopping treatment in virological and immunological failures of potent antiretroviral therapy

Abstract: CMV disease recurs after virological and immunological failure of HAART if CD4 cell counts drop below 50. In this situation, anti-CMV agents should be resumed before clinical reactivation ensues, because of the risk of contralateral retinal involvement and systemic disease.

Cited by 76 publications

References 22 publications

Cytomegalovirus (CMV)–Specific CD4⁺T Lymphocyte Immune Function in Long‐Term Survivors of AIDS‐Related CMV End‐Organ Disease Who Are Receiving Potent Antiretroviral Therapy

Cytomegalovirus (CMV)–Specific CD4⁺T Lymphocyte Immune Function in Long‐Term Survivors of AIDS‐Related CMV End‐Organ Disease Who Are Receiving Potent Antiretroviral Therapy

Mycobacterium Avium in Pygmy Rabbits (Brachylagus Idahoensis): 28 Cases

Canadian Consensus Guidelines for the Management of Cytomegalovirus Disease in HIV/AIDS

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CMV retinitis recurs after stopping treatment in virological and immunological failures of potent antiretroviral therapy

Abstract: CMV disease recurs after virological and immunological failure of HAART if CD4 cell counts drop below 50. In this situation, anti-CMV agents should be resumed before clinical reactivation ensues, because of the risk of contralateral retinal involvement and systemic disease.

Cited by 76 publications

References 22 publications

Cytomegalovirus (CMV)–Specific CD4+T Lymphocyte Immune Function in Long‐Term Survivors of AIDS‐Related CMV End‐Organ Disease Who Are Receiving Potent Antiretroviral Therapy

Cytomegalovirus (CMV)–Specific CD4+T Lymphocyte Immune Function in Long‐Term Survivors of AIDS‐Related CMV End‐Organ Disease Who Are Receiving Potent Antiretroviral Therapy

Mycobacterium Avium in Pygmy Rabbits (Brachylagus Idahoensis): 28 Cases

Canadian Consensus Guidelines for the Management of Cytomegalovirus Disease in HIV/AIDS

Contact Info

Product

Resources

About

Cytomegalovirus (CMV)–Specific CD4⁺T Lymphocyte Immune Function in Long‐Term Survivors of AIDS‐Related CMV End‐Organ Disease Who Are Receiving Potent Antiretroviral Therapy

Cytomegalovirus (CMV)–Specific CD4⁺T Lymphocyte Immune Function in Long‐Term Survivors of AIDS‐Related CMV End‐Organ Disease Who Are Receiving Potent Antiretroviral Therapy