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.2004.05.028

Cited by 96 publications

(78 citation statements)

References 34 publications

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“…In this patient there was an important increase in CD4+ count (126 cells/mm 3 before HAART to 336 cells/mm 3 during the onset of IRV) as described by JABS et al 16 . This case of IRV occurred later in the course of immune recovery than has been previously described 14,21 , suggesting that this event might occur even in patients showing long-term CD4+ response to HAART therapy.…”

Section: Discussionsupporting

confidence: 68%

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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Section: Discussionsupporting

confidence: 68%

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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“…1,2 The most frequent posterior segment disease in patients infected with human immunodeficiency virus (HIV) is HIV retinopathy, an ischemic retinopathy ophthalmoscopically characterized by cotton-wool spots and intraretinal hemorrhages. 3 Pepose and others 4 have shown that in HIV-positive patients the microangiopathy leads to loss of inner retinal structures including the vasculature and ganglion cells and that this is associated with retinal capillary and vascular loss.…”

mentioning

confidence: 99%

Objective analysis of retinal damage in HIV-positive patients in the HAART era using OCT

Kozák

Bartsch

Cheng

et al. 2005

American Journal of Ophthalmology

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PURPOSE-To assess retinal nerve fiber layer (RNFL) thickness in patients with human immunodeficiency virus (HIV) disease without cytomegalovirus retinitis (CMV). DESIGN-A case-control study.METHODS-The study included 113 eyes of 65 patients in one center. Thickness of RNFL along a 3.4-mm-diameter circle centered on the optic nerve head was evaluated using third-generation optical coherence tomography. Patients in group A (39 eyes of 22 patients) were human immunodeficiency virus-negative control subjects. Group B (36 eyes of 18 patients) was composed of HIV patients with no history of CMV retinitis and CD4 counts consistently above 100. Group C (38 eyes of 25 patients) comprised HIV patients with no history of CMV retinitis but a history of CD4 count less than 100 at some point lasting for at least 6 months. RESULTS-The average RNFL thicknesses in groups A, B, and C were 103.33 ± 8.50 μm, 103.30 ± 9.28 μm, and 90.10 ± 12.50 μm, respectively. Group C had significantly thinner overall RNFL than either of the groups A and B (Tukey-Kramer). This difference was most prominent in temporal, superior, and inferior retinal areas. No difference was in nasal retinal area, nor between groups A and B in any of the areas.

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“…Ocular manifestations have been reported in 70-80% of individuals infected with HIV,andcan involve any ocular structures anterior to posterior (Holland, 1992;Biswas et al, 2000). Since, the introduction of highly active antiretroviral therapy (HAART) in late 1996, there is marked case reduction in acquired immune deficiency syndrome (AIDS) -related morbidity and mortality (Jabs, 1997(Jabs, , 2002Jacobson, 1997Jacobson, , 2000Palella et al, 1998). …”

Section: Introductionmentioning

confidence: 99%

Eye changes among HIV positive patients on antiretroviral therapy in Nepal

2016

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Background: HIV/AIDS has various ocular manifestations. Objective: To find out eye findings among HIV positive patients in the era of antiretroviral therapy. Method This Hospital based cross sectional descriptive study was carried at B. P. Koirala Lions Centre for Ophthalmic Studies. Patient profile, WHO clinical stage, CD4+ cell count, duration of HIV, antiretroviral therapy, and systemic diseases were recorded. All the cases underwent ocular examination as per the study protocol and the findings were noted in a proforma developed for the study. The results were analysed with SPSS 14.0. Results: Of 100 HIV positive cases (including 55 antiretroviral therapy patients) 62% patients were male and 38% were female. The mean age of presentation was 27.72 years. Heterosexual transmission (62%) was the commonest mode of transmission of HIV. Thirty seven percent patients were illiterate. Systemic disease was present in 20% cases. Ocular complaint was present in 53% patients. Ocular disease was present in 40% HIV positive patients. Almost 55% of these cases were on antiretroviral therapy. Moderate to lower CD4 count patient had frequent eye disease. Patients in WHO Stage III and IV also had frequent eye problems. Anterior segment and external ocular disorder was present in 25% patients. The commonest manifestation was conjunctivitis in10% of total cases. Posterior segment manifestation was present in 11%, neuro-ophthalmic lesion in 4% and orbital lesion in 1% patient. Conclusion: Anterior segment manifestation is still common ocular manifestations in HIV positive patients in Nepal. Patients in WHO Stage III and IV are more vulnerable for eye changes. Young aged male and migrant workers are at risk of acquiring HIV in developing country like Nepal. Eye findings even in patientson antiretroviral therapy are similar. However, large sample size and long follow up study is required to have final disclosure.

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

Cited by 96 publications

References 34 publications

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

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

Objective analysis of retinal damage in HIV-positive patients in the HAART era using OCT

Eye changes among HIV positive patients on antiretroviral therapy in Nepal

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