Cytomegalovirus retinitis in acquired immunodeficiency syndrome patients: A problem worth giving attention to

Abstract

Background:Cytomegalovirus (CMV) retinitis remains the most common ocular opportunistic infection in patients with acquired immunodeficiency syndrome even in the era of highly active antiretroviral therapy (HAART). Increased survival of patients on HAART has increased incidence of blindness, which will further increase in the future. The objective of this study was to determine the incidence of CMV retinitis and the effect of HAART on the natural history of CMV retinitis in patients referred from ART center.Materials and Methods:Patients with baseline/current CD4 counts <150 cells/µl were evaluated for CMV retinitis. Complete ophthalmological evaluation was carried out and records of CD4 counts, HAART regime, presence of any form of CMV retinitis and response to HAART were noted.Results:Out of 800 patients registered with CD4 <150 cells/µl in ART center, 100 patients reached us. Among these, CMV retinitis was observed in 15% patients, with median CD4 count at the time of examination being 56 cells/µl (range: 24-306 cells/µl). 66.67% patients were HAART non-responders and 63.6% eyes were economically blind.Conclusion:CMV retinitis occurs even in patients with higher CD4 counts. Timely diagnosis and intervention of this treatable condition can reduce the number of blinding years in these young patients who otherwise live longer as a result of HAART.

Cytomegalovirus Infection Associated with Severe Intraocular Inflammation in an HIV Patient: A Case Report

“…CMV retinitis mostly occurs in patients with CD4 + T-cell counts <100 cells/mm 3 and shows a higher prevalence in males between the second and fifth decades of life. The disease is usually bilateral and presents with a substantial loss of VA in the affected eye/s [1,3]. All these traits were found in our patient, except for a bilateral involvement.…”

“…Although its incidence has decreased in the era of HAART [2], CMV retinitis continues to affect patients with late-stage HIV. This can be due to the current increased survival rates of HIV patients as also to antiretroviral drug resistance [3].…”

“…The incidence rate observed during follow-up in LSOCA was 0.4/100 person-years [2]. There are definite risk factors for the development of an active CMV eye infection, especially a low CD4 + T-cell count, with cutoff values of the latter being set at 50 to 100 cells/mm 3 , although some variations in these figures can be found between authors [3]. As a consequence of such low CD4 + T-cell counts, CMV active infections typically occur with little inflammation.…”

Variability at the 3′ untranslated region of the HLA-G gene: a study on patients with AIDS and cytomegalovirus retinochoroiditis

“…Although the frequency of CMV-R has been decreased due to the universal access of patients with AIDS to the combination antiretroviral therapy (cART), retinochoroiditis continues to be an important cause of severe visual loss, particularly in countries where cART is not freely available 1 . Thus, the identification of AIDS patients prone to develop CMV-R, the early diagnosis and early treatment may propiciate a reduction on the number of years of blindness in patients whose survival is favored by cART 2 .…”