Comparison of Visual Prognosis and Clinical Features of Cytomegalovirus Retinitis in Hiv and Non-Hiv Patients

Kim, Dong Yoon; Jo, Jaehyuck; Joe, Soo Geun; Kim, June-Gone; Yoon, Young Hee; Lee, Joo Yong

doi:10.1097/iae.0000000000001144

Cited by 33 publications

(35 citation statements)

References 21 publications

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“…CMVR is the most common ocular opportunistic infection and the leading cause of blindness associated with AIDS worldwide [48][49][50][51][52]. CMVR occurs in approximately 20-40% of HIV-infected patients and accounts for 90% of HIV-related blindness [6,20,52]. In the literature to date, the most significant predictor for the development of CMVR is a CD4+ count less than 50 cells/µL [34,46,[53][54][55].…”

Section: Cmvr In Hivmentioning

confidence: 99%

“…As early cases tend to be asymptomatic, symptoms tend to translate into more severe retinitis, early involvement of the macula, or possible infiltration of the optic nerve [48,49]. Kim et al found that the vision at presentation did not significantly differ between the HIV and non-HIV immunosuppressed patients [6]. Lu et al did note worse presenting vision in non-HIV immunosuppressed patients, most likely because their patients were significantly immunocompromised, as the majority of them had hematologic malignancies and had received intensive chemotherapy shortly before presentation [4].…”

Section: Clinical Presentation: Hiv and Non-hiv Patientsmentioning

confidence: 99%

“…As CMVR progresses, the retina becomes atrophic and can develop tears which can result in retinal detachment. CMVR is more commonly seen in HIV patients, likely due to the degree of immune suppression required for manifestation and there are few studies that directly compare HIV and non-HIV CMVR patients [6,91]. When classic retinitis findings are present, the prevalence of fulminant versus indolent forms of retinitis have been observed to be similar in HIV and non-HIV patients [91].…”

Section: Clinical Presentation: Hiv and Non-hiv Patientsmentioning

confidence: 99%

“…In the absence of known immune suppression, ocular manifestations of CMVR should raise suspicion for human immunodeficiency virus (HIV) infection and is classified as an acquired immunodeficiency syndrome (AIDS) defining illness [4,5]. CMVR may also be seen in other conditions associated with immunosuppression, including solid organ transplants, hematologic malignancy, and drug-induced immunosuppression [4,6].…”

Section: Introductionmentioning

confidence: 99%

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Cytomegalovirus Retinitis in HIV and Non-HIV Individuals

et al. 2019

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Cytomegalovirus retinitis (CMVR) is a severe, vision-threatening disease that primarily affects immunosuppressed patients. CMVR is the most common ocular opportunistic infection in human immunodeficiency virus (HIV) infected patients and is the leading cause of blindness in this group; however, the incidence of CMVR in HIV patients has dramatically decreased with antiretroviral therapy. Other causes of immunosuppression, including organ transplantation, hematologic malignancies, and iatrogenic immunosuppression, can also lead to the development of CMVR. Herein, we describe the pathogenesis of CMVR and compare clinical features, epidemiology, and risk factors in HIV and non-HIV infected individuals with CMVR.

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Section: Cmvr In Hivmentioning

confidence: 99%

Section: Clinical Presentation: Hiv and Non-hiv Patientsmentioning

confidence: 99%

Section: Clinical Presentation: Hiv and Non-hiv Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cytomegalovirus Retinitis in HIV and Non-HIV Individuals

et al. 2019

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“…Vision loss occurs as a result of posterior pole involvement with retinal necrosis involving the macula or optic nerve, or as a result of complications including retinal detachment (RD), epiretinal membrane (ERM) or cataract [35, 36]. The clinical features of CMVR do not differ between individuals with HIV infection and those with immune compromise from other causes [37]. …”

Section: Clinical Signs and Symptomsmentioning

confidence: 99%

Cytomegalovirus Retinitis in the Post-cART Era

Port

Alabi

Koenig

et al. 2018

Curr Ophthalmol Rep

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Purpose of review: To review the epidemiology, diagnosis, and management of cytomegalovirus retinitis (CMVR) in the post-combined antiretroviral era (cART) era. Recent findings: Although cART has dramatically reduced CMVR incidence and morbidity in the HIV population, CMVR continues to cause significant vision loss in both HIV and non-HIV patients, especially amongst patients without immune reconstitution. Advances in imaging including ultra-widefield fundus and autofluorescence imaging, optical coherence tomography, and adaptive optics may reflect CMVR activity; however, the diagnosis remains a clinical one. There have been minimal advances in therapy, with several agents no longer available due to market concerns. Summary: Despite reduced incidence and morbidity in the post-cART HIV population, CMVR continues to cause vision loss amongst HIV and non-HIV patients. Diagnosis remains primarily clinical, and therapy centers upon immune reconstitution along with systemic and/or intravitreal antivirals. Further studies are necessary to determine whether advanced imaging can influence management, and whether novel antiviral agents or adoptive immune transfer have a role in treatment of drug-resistance CMVR.

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Clinical features of cytomegalovirus retinitis after solid organ transplantation versus hematopoietic stem cell transplantation

Son

Lee

Kim

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Purpose To investigate and compare the clinical features of cytomegalovirus (CMV) retinitis after solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) and to determine the poor prognostic factors. Methods Patients consulted to the ophthalmology department for CMV viremia after transplantation between March 2008 and February 2018 and followed for more than 6 months were analyzed. Medical records regarding demographic, serologic, and ocular characteristics were compared between the SOT and HSCT groups. Factors associated with poor visual outcomes were determined with logistic regression. Results CMV retinitis developed in 11.3% of patients with CMV viremia following transplantation. In the SOT group (25 eyes/ 18 patients) and the HSCT group (33 eyes/21 patients), CMV retinitis occurred at 5.8 months and 3.7 months post-transplantation, respectively. Mortality was significantly higher in the HSCT group (52.4% vs. 5.6%, P < 0.001). During the mean 11.7 months of follow-up, visual acuity tended to be aggravated (P = 0.087) despite antiviral treatment, which was especially notable in the SOT group (P = 0.028). Six eyes (10.3%) underwent vitrectomy due to retinal detachment, most of which (5 eyes) were in the SOT group. Multivariate logistic regression analysis showed that the presence of concurrent CMV disease (OR = 14.11, P = 0.009) and foveal involvement (OR = 114.85, P = 0.001) were poor prognostic factors. Conclusion Clinical manifestations of CMV retinitis differed between the HSCT and SOT group. Concurrent CMV diseases and foveal involvement were associated with poor visual outcomes in CMV retinitis following transplantation.

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Comparison of Visual Prognosis and Clinical Features of Cytomegalovirus Retinitis in Hiv and Non-Hiv Patients

Cited by 33 publications

References 21 publications

Cytomegalovirus Retinitis in HIV and Non-HIV Individuals

Cytomegalovirus Retinitis in HIV and Non-HIV Individuals

Cytomegalovirus Retinitis in the Post-cART Era

Clinical features of cytomegalovirus retinitis after solid organ transplantation versus hematopoietic stem cell transplantation

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