AIDS-CMV retinitis: Singapore's first cases

Abstract

Since April 1988, four cases of AIDS-CMV retinitis were diagnosed in Singapore. Two patients were given intravenous ganciclovir. Clinical response was good but recurrent episodes of breakthrough infection occurred in one patient despite maintenance therapy. Another patient was started on intravenous foscarnet. The fourth patient succumbed to systemic AIDs-related infection before therapy could be started. AIDS-CMV retinitis is a new disease entity in Singapore. With increasing number of AIDS patients, more cases can be expected in the near future. Early treatment and long term maintenance therapy is essential for preserving sight.

PIP: Cytomegalovirus retinitis, the most frequently encountered ophthalmologic manifestation of acquired immunodeficiency syndrome (AIDS), emerges in up to 46% of such patients. In the period between april 1989-May 1990, 4 cases of AIDS-related cytomegalovirus retinitis were diagnosed in Singapore and treated at Tan Tock Hospital. Presenting complaints included blurred vision, visual field scotoma, and a field defect. Clinically, cytomegalovirus retinitis is characterized by lesions, usually in the posterior pole, that take the form of fluffy white infiltrates with irregular, translucent, granular appearing margins. There is associated retinal hemorrhage and inflammatory sheathing, leading eventually to a profound loss of vision. The treatment of choice is ganciclovir, and the lack of enlargement of existing lesions is the indicator of successful maintenance therapy. Since ganciclovir is virustatic rather than virucidal, continuous treatment is required to prevent reactivation. Even with full maintenance therapy, 30-50% of patients experience breakthrough infection. Complications of ganciclovir include conjunctival scarring, scleral induration, and neutropenia. Moreover, ganciclovir cannot be taken concurrently with zidovudine, a drug that promotes the overall well-being and survival status of AIDS patients. The development of new drugs such as foscarnet is expected to eliminate the need for AIDS patients to make a choice between preserving their eyesight and controlling virus replication.