Routine Immediate Eye Examination at the Point of Care for Diagnosis of AIDS-Related Cytomegalovirus Retinitis Among Patients With a CD4 Count &amp;lt;100 in Myanmar

Sin, Win Le Shwe; Soe, Kyi Pyar; Hilbig, Adelene; Murray, Jillian; Heiden, David

doi:10.1093/ofid/ofz280

Cited by 3 publications

(4 citation statements)

References 11 publications

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“…Such observations again support the need for universal screening for all patients with a CD4 < 100 cells/ μL [1,4]. After the inception of the CMVR programme in our clinic, the detection rate of CMVR among patients with CD4 < 100 cells/μL was 10.7% [16].…”

Section: Discussionsupporting

confidence: 75%

“…IOG injections are invasive, are traumatic for patients and care providers, and are associated with possible complications including blindness. Although we and others have shown that HIV clinicians can be trained to safely perform IOG injections, this has not been scaled up [9,10,15,16]. In many countries, only ophthalmologists are sanctioned to perform intraocular injections [1].…”

Section: Discussionmentioning

confidence: 99%

“…Since February 2013, diagnosis and treatment for CMVR has been provided at MTY. HIV clinicians with no previous ophthalmology experience were trained in indirect ophthalmoscopy and CMVR management, including administration of IOG, as described elsewhere [9,10,15,16]. Indirect ophthalmoscopy was the only diagnostic strategy for CMVR available, as other investigations commonly utilized in HIC, including CMV polymerase chain reaction (PCR), were not available in rural southern Myanmar.…”

Section: Programmentioning

confidence: 99%

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Treating HIV-associated cytomegalovirus retinitis with oral valganciclovir and intra-ocular ganciclovir by primary HIV clinicians in southern Myanmar: a retrospective analysis of routinely collected data

et al. 2020

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Background Cytomegalovirus retinitis (CMVR) is an opportunistic infection in HIV-infected people. Intraocular or intravenous ganciclovir was gold standard for treatment; however, oral valganciclovir replaced this in high-income countries. Low- and middle-income countries (LMIC) frequently use intraocular injection of ganciclovir (IOG) alone because of cost. Methods Retrospective review of all HIV-positive patients with CMVR from February 2013 to April 2017 at a Médecins Sans Frontièrs HIV clinic in Myanmar. Treatment was classified as local (IOG) or systemic (valganciclovir, or valganciclovir and IOG). The primary outcome was change in visual acuity (VA) post-treatment. Mortality was a secondary outcome. Results Fifty-three patients were included. Baseline VA was available for 103 (97%) patient eyes. Active CMVR was present in 72 (68%) eyes. Post-treatment, seven (13%) patients had improvement in VA, 30 (57%) had no change, and three (6%) deteriorated. Among patients receiving systemic therapy, four (12.5%) died, compared with five (24%) receiving local therapy (p = 0.19). Conclusions Our results from the first introduction of valganciclovir for CMVR in LMIC show encouraging effectiveness and safety in patients with advanced HIV. We urge HIV programmes to include valganciclovir as an essential medicine, and to include CMVR screening and treatment in the package of advanced HIV care.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Programmentioning

confidence: 99%

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Treating HIV-associated cytomegalovirus retinitis with oral valganciclovir and intra-ocular ganciclovir by primary HIV clinicians in southern Myanmar: a retrospective analysis of routinely collected data

et al. 2020

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“…Therefore, the early diagnosis of both HIV and CMV infection is particularly important. CD4+ T lymphocyte counts have been used to predict the onset of several ocular infections in HIV-positive persons (Douek et al, 2009); for example, studies have shown that patients with HIV infection with CD4 + T lymphocyte counts below 100 cells/µL often have retinal or conjunctival microangiopathy as well as CMV retinitis (Ei et al, 2019). Moreover, 30% of PLHIVs with CD4 + T lymphocyte counts below 50 cells/µL have CMV retinitis with blindness mainly due to posterior retinal detachment in these persons (Holbrook et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Clinical Features of Cytomegalovirus Retinitis in HIV Infected Patients

Tang

Sun

et al. 2020

Front. Cell. Infect. Microbiol.

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The purpose of this study was to investigate the clinical features and related laboratory indicators of cytomegalovirus retinitis in HIV infected patients in order to find a suitable laboratory reference guide to aid in the early diagnosis of CMVR, which should improve the prognosis of the severe retinitis. Methods: PLHIVs who were admitted to our hospital from January 2010 to December 2016 were included. The diagnosis of AIDS follows the AIDS Treatment Guidelines. Levels of CMV IgG and IgM were measured by ELISA in order to detect the CMV infection status of the patient. CMV-DNA levels were assessed by a quantitative PCR method, and CD4 + T lymphocytes were detected by flow cytometry. Logistical regression was used to analyze the risk factors for CMV retinitis in HIV-infected patients. Results: There were 93 patients with HIV that were also diagnosed with CMV retinitis. After ART, the intraocular pressure, visual acuity, cotton plaque incidence, and CD4 + T lymphocyte count were significantly improved, and the yellow-white retinal lesions gradually disappeared. In patients with HIV infections, the CD4+ T lymphocyte count, and peripheral blood quantitative CMV-DNA levels were found to be independent risk factors for CMV retinitis (P < 0.05). Patients with HIV infection who had CMV-DNA levels >6,390 copies/mL were associated with more severe ophthalmolgic conditions related to CMV retinitis. Conclusion: Patients with HIV infections with quantitative CMV-DNA levels >6,390 copies/mL have a higher probability of having a diagnosis of CMV retinitis and a worse prognosis than those whose CMV-DNA level is <6,390 copies/mL.

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Temporal trends in ocular manifestations of HIV/AIDS patients in the past 18 years in a tertiary hospital in China

2022

Graefes Arch Clin Exp Ophthalmol

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Routine Immediate Eye Examination at the Point of Care for Diagnosis of AIDS-Related Cytomegalovirus Retinitis Among Patients With a CD4 Count <100 in Myanmar

Cited by 3 publications

References 11 publications

Treating HIV-associated cytomegalovirus retinitis with oral valganciclovir and intra-ocular ganciclovir by primary HIV clinicians in southern Myanmar: a retrospective analysis of routinely collected data

Treating HIV-associated cytomegalovirus retinitis with oral valganciclovir and intra-ocular ganciclovir by primary HIV clinicians in southern Myanmar: a retrospective analysis of routinely collected data

Clinical Features of Cytomegalovirus Retinitis in HIV Infected Patients

Temporal trends in ocular manifestations of HIV/AIDS patients in the past 18 years in a tertiary hospital in China

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