Cytomegalovirus Retinitis: The Neglected Disease of the AIDS Pandemic

Heiden, David; Ford, Nathan; Wilson, David J.; Rodriguez, William; Margolis, Todd P.; Janssens, Bart; Bedelu, Martha; Tun, NiNi; Goemaere, Eric; Saranchuk, Peter; Sabapathy, Kalpana; Smithuis, Frank; Luyirika, Emmanuel; Drew, W. Lawrence

doi:10.1371/journal.pmed.0040334

Cited by 113 publications

(152 citation statements)

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“…[2] A total of 1 815 patients were enrolled into the PEPFAR-funded CAPRISA AIDS Treatment Programme (CAT) at the eThekwini site in Durban, South Africa (SA) between June 2004 and August 2013. In this report, we highlight the three patients in this cohort who developed CMV retinitis.…”

Section: In Practicementioning

confidence: 99%

Section: In Practicementioning

confidence: 99%

“…Furthermore, the importance of conducting routine ophthalmological examinations on patients presenting for ART initiation with advanced disease needs to be emphasised. [2,31,32] Visual loss adds to the overwhelming social and economic burden on patients and societies already plagued by HIV. We support the recommendation that routine fundoscopic examination be included in the standard WHO care package for HIV-infected patients with advanced disease.…”

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confidence: 99%

“…Data from Myanmar showed that 31% of the 42 patients diagnosed with CMV retinitis by fundoscopy, were asymptomatic. [2] Asymptomatic CMV retinitis was also demonstrated in 44% of Cambodian patients, despite the use of a questionnaire designed specifically to elicit symptoms of CMV retinitis.[2] While studies advocate education of patients with low CD4+ cell counts (<100 cells/µL) [10] on the risk of CMV retinitis, and highlight the need for urgent medical evaluation in patients presenting with ophthalmic symptoms, [33] there are still large numbers of asymptomatic CMV retinitis cases. This underscores the need for the inclusion of routine fundoscopy in treatment guidelines for patients with advanced stage HIV as well as investment in training and infrastructure to enable frontline workers to conduct routine fundoscopic examinations on eligible patients.…”

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Cytomegalovirus retinitis and HIV: Case reviews from KwaZulu-Natal Province, South Africa

et al. 2017

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Background.Retinal cytomegalovirus (CMV) infection is a common opportunistic infection and remains a significant contributor to visual loss in patients with AIDS. We highlight the poor outcomes of CMV retinitis in three HIV-infected patients who were initiated on antiretroviral therapy (ART). We conducted a retrospective chart review of advanced stage HIV-infected patients with known CMV retinitis. Case 1. A 37-year-old man, with a CD4+ cell count of 35 cells/µL, presented for ART initiation with a 5-month history of visual loss in his left eye. Fundoscopy showed left eye CMV retinitis and right eye HIV retinopathy. ART and 5 months of weekly intravitreal ganciclovir injections (left eye) were commenced. Six-month outcomes included virological suppression, and visual acuity in the right eye of 6/6 and in the left eye of 3/60. Case 2. A 31-year-old woman, with a CD4+ cell count of 39 cells/µL and on tuberculosis therapy, presented for ART initiation. She presented with a 2-month history of decreased visual acuity. Fundoscopy showed bilateral CMV retinitis, which was more pronounced in the left eye. ART and 8 months of intravitreal ganciclovir injections were commenced. Six-month outcomes included virological suppression and visual acuity in the right eye of 6/9, and in the left eye of 6/24. Case 3. A 29-year-old woman, with a CD4+ cell count of 24 cells/µL, who was on tuberculosis therapy and ART, complained of blurred vision at her 2-month ART follow-up visit. Fundoscopy showed bilateral retinal detachment secondary to CMV retinitis. While silicone oil tamponade and subsequent retinectomy successfully repaired the right eye, extensive damage rendered the left eye irreparable. Six-month outcomes included virological suppression, with 6/120 visual acuity in the right eye and complete blindness in the left eye. Conclusion. CMV retinitis causes debilitating, permanent sequelae, which is preventable by ART initiation at higher CD4+ cell counts. Despite achieving virological suppression, vision could not be completely restored in these patients, irrespective of the severity of CMV retinitis. Med J 2017;107(10):843-846. DOI:10.7196/SAMJ.2017.v107i10.12740 S Afr 844October 2017, Vol. 107, No. 10 IN PRACTICEdirect damage to the macula or optic nerve, resulting in permanent blindness.[2] Blindness caused by CMV retinitis is irreversible and can occur prior to complete retinal destruction, which was responsible for >90% of HIV-associated blindness in the pre-ART era. [2] A total of 1 815 patients were enrolled into the PEPFAR-funded CAPRISA AIDS Treatment Programme (CAT) at the eThekwini site in Durban, South Africa (SA) between June 2004 and August 2013. In this report, we highlight the three patients in this cohort who developed CMV retinitis.Approval for data collection and analysis for the CAT programme was obtained from the University of KwaZulu-Natal Biomedical Research Ethics Committee (ref. no. E248/05). Case reports Case 1In June 2011, a 37-year-old man presented for ART initiation with a baseline CD4+ cell co...

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Section: In Practicementioning

confidence: 99%

Section: In Practicementioning

confidence: 99%

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Cytomegalovirus retinitis and HIV: Case reviews from KwaZulu-Natal Province, South Africa

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“…[53][54] Cytomegalovirus retinitis is strongly linked to mortality, commonly underdiagnosed, and rarely treated with needed systemic drugs. 71 A study from Myanmar reported that a third of patients diagnosed with cytomegalovirus retinitis on eye screening and given only local intraocular ganciclovir failed to survive 3 months. 72 Cotton wool spots, present in 15-50% of patients with low CD4 counts, [52][53][54] are strongly associated with high HIV viral load.…”

Section: Personal Viewmentioning

confidence: 99%

Eye examination for early diagnosis of disseminated tuberculosis in patients with AIDS

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Saranchuk

Keenan

et al. 2016

The Lancet Infectious Diseases

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Incidence of Cytomegalovirus Retinitis in Patients With Human Immunodeficiency Virus Following Negative Initial Screening Examination Results

et al. 2012

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Cytomegalovirus Retinitis: The Neglected Disease of the AIDS Pandemic

Abstract: The authors describe CMV retinitis in resource-poor settings and suggest possibilities for management.

Cited by 113 publications

References 42 publications

Cytomegalovirus retinitis and HIV: Case reviews from KwaZulu-Natal Province, South Africa

Cytomegalovirus retinitis and HIV: Case reviews from KwaZulu-Natal Province, South Africa

Eye examination for early diagnosis of disseminated tuberculosis in patients with AIDS

Incidence of Cytomegalovirus Retinitis in Patients With Human Immunodeficiency Virus Following Negative Initial Screening Examination Results

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