Combined Antiretroviral Therapy Alone Does Not Prevent Active CMV Retinitis

Patients with AIDS-related cytomegalovirus (CMV) retinitis who are receiving combined antiretroviral therapy (cART) without specific anti-CMV therapy may have active retinitis for several months, according to results published in the British Journal of Ophthalmology.

The researchers reviewed medical records of participants with AIDS-related CMV retinitis who were examined at 5 HIV disease clinics in November 2006. Participants with nadir CD4+ T-lymphocyte counts <50 cells/mL or visual symptoms underwent indirect ophthalmoscopy. Participants with active retinitis were treated with weekly intraocular ganciclovir, 2.5 mg in 0.05 mL volume. The researchers evaluated the relationship between retinitis activity and cART duration by use of maximum likelihood logistic regression.

In total, 179 participants with HIV were examined by indirect ophthalmoscopy, and 36 participants with CMV retinitis were currently on cART and had never received specific anti-CMV therapy.

Among participants with CMV retinitis on cART, 19 had active CMV retinitis. Of 16 participants who were on cART for ≤14 weeks, all 16 had active retinitis. The researchers found that participants with CMV retinitis who had been on shorter courses of cART were more likely to have active disease (P <.001).

There were no significant differences in the clinical features of eyes with active and inactive CMV retinitis.

After 1 year of follow-up, the researchers re-examined 9 participants who had active CMV retinitis and were treated with intraocular ganciclovir; 7 others had been lost to follow-up and 3 had died. None of the eyes that had intact vision on initial evaluation and had been treated with specific anti-CMV therapy had become blind.

“Until there is widespread effective early HIV diagnosis and treatment in resource-limited settings, eye examination should be performed routinely on all patients who are vulnerable to CMV retinitis at the time they first enter healthcare, just as screening is provided for other serious opportunistic infections,” the researchers wrote.

Reference

Heiden D, Tun N, Smithuis FN, et al. Active cytomegalovirus retinitis after the start of antiretroviral therapy [published online September 8, 2018]. Br J Ophthalmol. doi:10.1136/ bjophthalmol-2018-312406