Cytomegalovirus Retinitis in the Post-cART Era

Abstract

Purpose of review: To review the epidemiology, diagnosis, and management of cytomegalovirus retinitis (CMVR) in the post-combined antiretroviral era (cART) era. Recent findings: Although cART has dramatically reduced CMVR incidence and morbidity in the HIV population, CMVR continues to cause significant vision loss in both HIV and non-HIV patients, especially amongst patients without immune reconstitution. Advances in imaging including ultra-widefield fundus and autofluorescence imaging, optical coherence tomography, and adaptive optics may reflect CMVR activity; however, the diagnosis remains a clinical one. There have been minimal advances in therapy, with several agents no longer available due to market concerns. Summary: Despite reduced incidence and morbidity in the post-cART HIV population, CMVR continues to cause vision loss amongst HIV and non-HIV patients. Diagnosis remains primarily clinical, and therapy centers upon immune reconstitution along with systemic and/or intravitreal antivirals. Further studies are necessary to determine whether advanced imaging can influence management, and whether novel antiviral agents or adoptive immune transfer have a role in treatment of drug-resistance CMVR.

Modified nucleic acids: replication, evolution, and next-generation therapeutics

“…Fomivirsen, a PS ASO to treat cytomegalovirus retinitis (CMV), was the first nucleic acid therapeutic to gain regulatory approval. It was subsequently withdrawn from the market due to a lack of demand as incidence of (CMV) infections decreased sharply [184]. Nevertheless, it proved an important step in demonstrating the safety and potential of nucleic acid medicines.…”

Macular Structure and Microvasculature Changes in AIDS-Related Cytomegalovirus Retinitis Using Optical Coherence Tomography Angiography

“…Cytomegalovirus retinitis (CMVR) is an all-important blind-causing disease but was once neglected in people with acquired immune deficiency syndrome (AIDS) ( 1 ). In recent years, apart from diagnosis and treatment, many studies on CMVR have focused on retinal imaging, including fundus photography, fluorescein angiography, fundus autofluorescence, spectral domain-optical coherence tomography (OCT), and adaptive optics ( 2 ). However, optical coherence tomography angiography (OCTA) has rarely been mentioned in patients with AIDS.…”

Clinical Characteristics Associated with the Development of Cystoid Macular Edema in Patients with Cytomegalovirus Retinitis

“…Cytomegalovirus (CMV) is a ubiquitous herpes family virus with a prevalence of approximately 50% in the latent form in the general population [ 1 , 2 ]. CMV retinitis is one of the most common opportunistic ocular infection in immunocompromised patients [ 3 , 4 ]. After the advent of antiretroviral therapy (ART), the incidence of CMV retinitis in patients infected with human immunodeficiency virus (HIV) declined and their visual outcomes improved [ 3 ].…”

“…After the advent of antiretroviral therapy (ART), the incidence of CMV retinitis in patients infected with human immunodeficiency virus (HIV) declined and their visual outcomes improved [ 3 ]. On the other hand, the incidence of CMV retinitis has been increasing in the past 15 years in non-HIV patients with diseases such as hematopoietic malignancy, solid organ transplantation, or autoimmune diseases [ 1 , 2 , 3 , 4 , 5 ].…”