Course of cytomegalovirus retinitis in the era of highly active antiretroviral therapy

Jabs, Douglas A.; Natta, Mark L. Van; Thorne, Jennifer E.; Weinberg, David V.; Meredith, Travis A.; Kuppermann, Baruch D.; Sepkowitz, Kent A.; Li, Helen K.

doi:10.1016/j.ophtha.2004.05.031

Cited by 89 publications

(48 citation statements)

References 35 publications

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“…Cytomegalovirus retinitis was diagnosed by a SOCA-certified ophthalmologist when the characteristic picture of a full-thickness necrotizing retinitis was present. 18-26 Patients with and without immune recovery were enrolled. Because the goal of this analysis was to evaluate the outcomes of patients diagnosed with CMV retinitis in the era of modern combination antiretroviral therapy, only participants with CMV retinitis diagnosed after 1996 were included in this analysis.…”

Section: Methodsmentioning

confidence: 99%

“…16,17 Despite this dramatic decrease in the incidence of CMV retinitis and the improved outcomes due to modern antiretroviral therapy, CMV retinitis and vision loss from CMV retinitis continue to occur. 18-21 Because antiretroviral-treated, immune-recovered, HIV-infected have an estimated lifespan of >14 years, 22 we evaluated the long-term outcomes of patients with AIDS and CMV retinitis enrolled in the Longitudinal Study of the Ocular Complications of AIDS (LSOCA) whose retinitis was diagnosed after the introduction of modern combination antiretroviral therapy.…”

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confidence: 99%

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Long-term Outcomes of Cytomegalovirus Retinitis in the Era of Modern Antiretroviral Therapy

et al. 2015

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Objectives To describe the long-term outcomes of patients with cytomegalovirus (CMV) retinitis and the acquired immunodeficiency syndrome (AIDS)in the modern era of combination antiretroviral therapy. Design Prospective, observational, cohort study Participants Patients with AIDS and CMV retinitis Testing Immune recovery, defined as a CD4+ T cell count>100 cells/μL for ≥ 3 months. Main outcome measures Mortality, visual impairment (visual acuity worse than 20/40) and blindness (visual acuity 20/200 or worse) on logarithmic visual acuity charts, loss of visual field on quantitative Goldmann perimetry. Results Patients without immune recovery had a mortality of 44.4/100 person years (PY), and a median survival of 13.5 months after the diagnosis of CMV retinitis, whereas those with immune recovery had a mortality of 2.7/100 PY (P<0.001), and an estimated median survival of 27.0 years after the diagnosis of CMV retinitis. The rates of bilateral visual impairment and blindness were 0.9/100 PY and 0.4/100 PY, respectively, and were similar between those with and without immune recovery. Among those with immune recovery, the rate of visual field loss was ~1% of the normal field/year, whereas among those without immune recovery it was ~7% of the normal field/year. Conclusions Among persons with CMV retinitis and AIDS, if there is immune recovery, long-term survival is likely, whereas if there is no immune recovery, the mortality rate is substantial. Although higher than the rates seen in the non-HIV-infected population, the rates of bilateral visual impairment and blindness are low, especially when compared to rates seen in the era before modern antiretroviral therapy.

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Section: Methodsmentioning

confidence: 99%

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Long-term Outcomes of Cytomegalovirus Retinitis in the Era of Modern Antiretroviral Therapy

et al. 2015

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“…25 26 Before HAART was introduced, 41.9%, 26.3%, and 14.7% of patients with baseline CD4 counts of 0-50×10 6 cells/L, 51-100×10 6 cells/L, and 101-250×10 6 cells/L, respectively, developed CMV retinitis over about two years. 27 Although HAART has reduced the incidence of CMV retinitis by about 75%, [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] it is still one of the most common opportunistic infections in patients with AIDS. With the introduction of HAART, the rate of progression to retinitis has decreased from 3 per patient year to 0.10 per patient year.…”

Section: Discussionmentioning

confidence: 99%

A brushfire in the eye

Khan

Rao

2016

BMJ

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“…The worldwide-accepted definition of immune recovery requires a HAART mediated elevation of CD4? T cell count over 100 cells/mm 3 for at least two months [34,35]. Although the total number of CD4?…”

Section: Discussionmentioning

confidence: 99%

Immune recovery uveitis associated with highly active antiretroviral therapy in a patient with CMV retinitis and AIDS despite a low CD4+ T cell count: case report and a review of the literature

Numan

Baykam²,

Kural

2009

Int Ophthalmol

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An unusual case of CMV retinitis and AIDS who developed immune recovery uveitis (IRU) despite a low CD4+ T cell count achieved during HAART is reported. A 36-year-old female complained of blurred vision in both eyes six months after initiation of anti-CMV retinitis therapy and HAART. Ocular examination revealed a substantial intraocular inflammation causing a dense vitreous haze and frosted branch angiitis. Consecutive CD4+ T cell counts were 20 cells/mm(3) or less and plasma HIV mRNA was undetectable. The laboratory test for Cytomegalovirus was positive whereas those for infections known to cause uveitis were negative. The inflammatory reaction resolved with treatment, but she developed retinal detachment just before she died of pulmonary complications. A review of the literature led us to propose that our patient developed an intraocular inflammation which may probably be a form of IRU and it might be appropriate to employ additional criteria in the definition and the diagnosis of IRU.

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Course of cytomegalovirus retinitis in the era of highly active antiretroviral therapy

Cited by 89 publications

References 35 publications

Long-term Outcomes of Cytomegalovirus Retinitis in the Era of Modern Antiretroviral Therapy

Long-term Outcomes of Cytomegalovirus Retinitis in the Era of Modern Antiretroviral Therapy

A brushfire in the eye

Immune recovery uveitis associated with highly active antiretroviral therapy in a patient with CMV retinitis and AIDS despite a low CD4+ T cell count: case report and a review of the literature

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