Cytomegalovirus retinitis in hospitalized people living with HIV in the late antiretroviral therapy era in São Paulo, Brazil

Abstract

Background There is scarce information on AIDS-related cytomegalovirus (CMV) retinitis in middle-income countries. The objectives of this study were to identify the prevalence of active CMV retinitis in severely immunosuppressed people living with HIV (PLWHIV) and to describe its main features. Methods This retrospective cohort study was carried out at a tertiary center in São Paulo, Brazil. We included hospitalized adults PLWHIV with CD4 count ≤100 cells/μL, ≥ one quantitation of CMV DNA in plasma, and indirect ophthalmoscopy evaluation. Results Thirty-eight (21.6%) of 176 participants had at least an ophthalmoscopy diagnosis and only 3 (1.7%) individuals presented active CMV retinitis. All these participants were male, and retinitis was asymptomatic in 2 cases. Two participants had extraocular end-organ CMV disease and detectable CMV DNA in plasma. Conclusions These results show a low prevalence of active CMV retinitis in the evaluated population. However, 2 of 3 participants had asymptomatic active CMV retinitis and a fifth of participants had at least one ophthalmoscopy diagnosis, suggesting the need for routine ophthalmologic evaluation in hospitalized severely immunosuppressed PLWHIV. The profile of participants with active CMV retinitis was similar to that described in the pre-ART era and quantitation of CMV DNA in plasma was variable.

AIDS-related gastrointestinal cytomegalovirus end-organ disease: A retrospective cohort study at a tertiary center in São Paulo, Brazil

“…Similar findings were observed in a prior study of CMV retinitis. 18 However, high values of quantitative detection of CMV-DNA in plasma (>50 000 IU/mL) were observed in the 2 patients of the present study with concomitant digestive system and neurological CMV-EOD, in CMV encephalitis cases, 27 and in CMV polyradiculopathy cases (J.E Vidal, personal communication). Therefore, it is possible that there is some relationship between the value of quantitative detection of CMV-DNA and the different clinical forms of CMV-EOD, particularly the neurological manifestations.…”

“…16,17 In the cART era, a recent prospective observational study of severely immunosuppressed cART-naive PLWHA reported that 12% of them had CMV-EOD; only one-third of them had retinitis, while two-thirds presented with histologically confirmed gastrointestinal illness. 5 In this line, a prior study carried-out in our hospital identified CMV retinitis in 1.7% of PLWHA with advanced immunosuppression, 18 less than a half of the percentage identified with digestive system CMV-EOD reported in the present study. These results confirm the epidemiological changes in the clinical profile of CMV-EOD in the cART era.…”