Regression of Cytomegalovirus Retinitis Associated With Protease-inhibitor Treatment in Patients With AIDS

Tanguilig, Gerald G.; Rutzen, Allan R.; Ortega-Larrocea, Gabriela

doi:10.1016/s0002-9394(14)70784-6

Cited by 86 publications

(19 citation statements)

References 18 publications

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“…The incidence of CMV-R has dramatically decreased in subjects treated with PI-based regimens when compared with those who did not receive these medications 11± 13 . Regression of disease has been described in patients treated solely with HAART 10,11,14 .…”

Section: Introductionmentioning

confidence: 99%

Protease inhibitor therapy is associated with markedly prolonged time to relapse and improved survival in AIDS patients with cytomegalovirus retinitis

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Chiller

et al. 2001

Int J STD AIDS

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Prior to the use of highly active antiretroviral therapy (HAART), cytomegalovirus retinitis (CMV-R) in AIDS patients was characterized by multiple relapses and decreased survival. Recent data suggest that CMV-R in patients treated with HAART may remain relapse-free for long periods. We performed a study of the effects of HIV protease inhibitors (PIs) on the incidence of relapse and time to death in AIDS patients with CMV-R treated with anti-CMV therapy. Medical records of all AIDS patients with CMV-R at Parkland Memorial Health and Hospital System treated with anti-CMV agents were reviewed for date of diagnosis of CMV-R, date of CMV-R relapse, type and duration of anti-CMV therapy, and duration of PI therapy. Relapse rates in subjects treated with PIs were compared with the relapse rates in those who were not treated with PIs. The primary endpoint was the time to relapse and death as determined by Kaplan-Meier analysis. Multivariate analysis was performed by Cox proportional hazard model. One hundred and nine cases of CMV-R were identified in 75 patients. Median follow-up time was 247 days (range 31-1818 days). There were 0.54 relapses per 1000 patient days in the group treated with PIs compared with 1.83 relapses per 1000 patient days in the non-PI treatment group (relative risk [RR]=0.29, P<0.01). Time to relapse was increased in the PI treatment group compared with the non-PI treatment group (endpoint not reached vs 182 days, P<0.001, log-rank). Similarly, the time to relapse or death was increased in the PI group compared with the non-PI group (543 days vs 103 days, P<0.001, log-rank). Multivariate analysis utilizing the Cox proportional hazards model demonstrated that only PI therapy but not anti-CMV therapy was associated with decreased risk of CMV-R relapse or death. Only 3 patients with an undetectable HIV viral load and one patient with a CD4 count >120 cells/microl had a relapse. We conclude that patients with CMV-R treated with HAART containing a PI have increased time to relapse and have prolonged survival.

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Section: Introductionmentioning

confidence: 99%

Protease inhibitor therapy is associated with markedly prolonged time to relapse and improved survival in AIDS patients with cytomegalovirus retinitis

Skiest

Chiller

et al. 2001

Int J STD AIDS

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“…Several months of highly active antiretroviral therapy (HAART) delays the progression of CMV retinitis, despite stopping all anti-CMV treatment, suggesting a certain immune restitution 3. This concept is also suggested by the appearance of a posterior segment inflammation in some patients treated by HAART 4…”

mentioning

confidence: 99%

Cystoid macular oedema and cytomegalovirus retinitis in patients with HIV disease treated with highly active antiretroviral therapy

Cassoux

Lumbroso

Bodaghi

et al. 1999

British Journal of Ophthalmology

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A significant vitreous inflammation (1.5+) was observed in eight eyes. All patients had been treated with anti-CMV drugs for a mean period of 18 months (range 12-36 months). All nine patients received HAART with a combination of two nucleotide analogue reverse transcriptase inhibitors and one protease inhibitor for a mean period of 14 months (range 9-18 months). The HIV viral load was below detectable levels (<200 copies/ml) in eight patients and low (3215 copies/ml) in one. At the time of CMO, the median CD4+ lymphocyte count was 232 cells × 10 6 /l (range 99-639). Conclusion-In AIDS patients, the usual absence of intraocular inflammation in eyes aVected by CMV retinitis has been tentatively explained by the profound cellular immunodeficiency. In these patients, treated with HAART, CD4+ counts were increased for several months (mean 14 months). In their eyes, CMV retinitis was associated with significant ocular inflammation and CMO. These findings could be related to the restoration of immune competence after HAART as recently shown. (Br J Ophthalmol 1999;83:47-49)

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“…The positive effects of HAART on the CD4 T cell, and HAART's ability to partially restore the T-cell repertoire even in advanced AIDS [11••], has led to a previously unthinkable practice of discontinuing secondary prophylaxis for CMV retinitis. Table 3 summarizes data from separate sources [36][37][38][39][40][41][42][43][44][45][46][47] that cumulatively studied 180 HAART recipients with healed CMV retinitis who discontinued specific anti-CMV therapy and were followed-up for a mean of 5 to 25 months. The CD4 cell counts at the time of stopping specific anti-CMV therapy ranged from as low as 60 to as high as 770 cells/ mm 3 .…”

Section: Discontinuation Of Cytomegalovirus Maintenance Therapymentioning

confidence: 99%

Therapy and prevention of cytomegalovirus retinitis

Kurup

Torriani

2001

Curr Infect Dis Rep

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Highly active antiretroviral therapy (HAART) has redefined the natural history of cytomegalovirus (CMV) retinitis. Once a major cause of blindness in AIDS patients, its incidence has plummeted and its clinical course has been altered. The potential of HAART for immunologic restoration should guide treatment decisions, and may ultimately lead to the possibility of withdrawal from maintenance anti-CMV therapy. However, new cases of CMV retinitis have begun to emerge in virologic and immunologic failures to HAART. The impact of HAART continues to evolve with the discovery of sight-threatening immune recovery uveitis. Specific anti-CMV treatment strategies have expanded and improved to include therapeutic options not requiring the parenteral route of administration such as valganciclovir, which has enhanced oral bioavailability.

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Regression of Cytomegalovirus Retinitis Associated With Protease-inhibitor Treatment in Patients With AIDS

Cited by 86 publications

References 18 publications

Protease inhibitor therapy is associated with markedly prolonged time to relapse and improved survival in AIDS patients with cytomegalovirus retinitis

Protease inhibitor therapy is associated with markedly prolonged time to relapse and improved survival in AIDS patients with cytomegalovirus retinitis

Cystoid macular oedema and cytomegalovirus retinitis in patients with HIV disease treated with highly active antiretroviral therapy

Therapy and prevention of cytomegalovirus retinitis

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