Cytomegalovirus Retinitis in Patients with AIDS before and after Introduction of HAART in China

Sun, Hui; Xiao, Peng; Li, Dan; Mao, Fei Fei; You, Qi Sheng; Jonas, Jost B.

doi:10.5301/ejo.5000354

Cited by 5 publications

(6 citation statements)

References 27 publications

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“…CMV and HIV also have been found to transactivate each other leading to a greater degree of immune suppression in HIV patients, a possible explanation for why we see CMVR more commonly in HIV patients as opposed to non-HIV immune suppressed individuals [57]. Additional risk factors include lower CD8 T-lymphocyte counts, higher HIV blood level, lack of antiretroviral therapy, and male gender [55,56].…”

Section: Cmvr In Hivmentioning

confidence: 88%

“…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]. While CMVR at higher CD4 counts is uncommon, a lower CD4+ T-lymphocyte count is strongly associated with increased retinal whitening and has been observed to be independent of other documented risk factors for CMVR [55,56].…”

Section: Cmvr In Hivmentioning

confidence: 99%

“…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]. While CMVR at higher CD4 counts is uncommon, a lower CD4+ T-lymphocyte count is strongly associated with increased retinal whitening and has been observed to be independent of other documented risk factors for CMVR [55,56]. CMV and HIV also have been found to transactivate each other leading to a greater degree of immune suppression in HIV patients, a possible explanation for why we see CMVR more commonly in HIV patients as opposed to non-HIV immune suppressed individuals [57].…”

Section: Cmvr In Hivmentioning

confidence: 99%

“…In addition to a low CD4+ cell count, individuals with low CD8+ cell counts are also at high risk for CMVR development and independently, CD8+ cells are predictive for CMVR development [55]. Specifically, patients with CD4+ cell counts <50 cells/µL and CD8+ cell counts <520 cells/µL may be at elevated risk [1,48,55]. HIV viral load levels may also impact CMV reactivation.…”

Section: Cmvr In Hivmentioning

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: 88%

Section: Cmvr In Hivmentioning

confidence: 99%

Section: Cmvr In Hivmentioning

confidence: 99%

Section: Cmvr In Hivmentioning

confidence: 99%

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Cytomegalovirus Retinitis in HIV and Non-HIV Individuals

et al. 2019

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“…This disease occurred in up to one-third of HIVinfected patients before the invention of highly active anti retroviral therapy (HAART) and significantly associated with CD4+ T-lymphocyte cell count <50 cells/mm 3 . 8,9 The incidence of CMV retinitis in the post-HAART era is estimated to be at most 5.6 cases/100 persons/year. 10 CMV retinitis is characterized by typical white, crumbly areas of retinal necrosis and hemorrhage which is sight threatening if originate in posterior pole.…”

mentioning

confidence: 99%

Challenges in Cytomegalovirus (CMV) Retinitis Management

et al. 2019

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Introduction: HIV infection can manifest in a variety of ways in and around the eyes and it is most commonly due to retinal microvasculopathy, neoplasm and also opportunistic infection. Those usually occur associated with a significantly reduced CD4 T-cell counts. In this era of Highly Active Anti Retroviral Therapy (HAART) has caused a major decreasing of the ocular involvement prevalence itself. Case report:A 31 year-old-male came with blurred vision on the right eye, which has started 3 years ago and slowly worsened. Central scotoma also presented previously. Patient was an HIV-AIDS, that placed him on HAART. CD4+ T-lymphocyte count was 3 cells/mm 3 . The initial visual acuity was light perception and fundus examination showed Roth spots, massive exudates and hemorrhages covering the optic disc and decreased foveal reflex. Laboratory examination revealed positive Rubella and anti-CMV immunoglobulin-G (IgG). He also suffered from lung tuberculosis and took tuberculosis medication regularly. Patient was diagnosed with Cytomegalovirus (CMV) retinitis based on history of illness, fundus examination as well as laboratory testing and given oral induction valganciclovir 900 mg once daily for 3 weeks followed by maintenance dosage.Result: After valganciclovir induction, there was significant changes with decreased peripapillary exudates, hemorrhages and vasculitis, but the optic disc appeared pale. The patient also had bicytopenia due to valganciclovir therapy that complicate his condition and passed away after 3 months follow up.Conclusion: CMV retinitis is reported to occur in patient with extreme CD4 count usually less than 50 cells/mm 3 . The sooner of proper treatment would likely following better outcome. Making diagnosis of immunosuppresed patient with ocular manifestations was challenging so that comprehensive eye examination in HIV-infected individuals should be conducted. Oral valganciclovir could give satisfactory response to decrease the progression of retinitis but risk of blindness may still occur.

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