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. 2010 Apr 26:4:285-99.
doi: 10.2147/opth.s6700.

Optimal management of cytomegalovirus retinitis in patients with AIDS

Michael W Stewart  1
Affiliations

Optimal management of cytomegalovirus retinitis in patients with AIDS

Michael W Stewart. Clin Ophthalmol. .

Abstract

Cytomegalovirus (CMV) retinitis is the most common cause of vision loss in patients with acquired immunodeficiency syndrome (AIDS). CMV retinitis afflicted 25% to 42% of AIDS patients in the pre-highly active antiretroviral therapy (HAART) era, with most vision loss due to macula-involving retinitis or retinal detachment. The introduction of HAART significantly decreased the incidence and severity of CMV retinitis. Optimal treatment of CMV retinitis requires a thorough evaluation of the patient's immune status and an accurate classification of the retinal lesions. When retinitis is diagnosed, HAART therapy should be started or improved, and anti-CMV therapy with oral valganciclovir, intravenous ganciclovir, foscarnet, or cidofovir should be administered. Selected patients, especially those with zone 1 retinitis, may receive intravitreal drug injections or surgical implantation of a sustained-release ganciclovir reservoir. Effective anti-CMV therapy coupled with HAART significantly decreases the incidence of vision loss and improves patient survival. Immune recovery uveitis and retinal detachments are important causes of moderate to severe loss of vision. Compared with the early years of the AIDS epidemic, the treatment emphasis in the post- HAART era has changed from short-term control of retinitis to long-term preservation of vision. Developing countries face shortages of health care professionals and inadequate supplies of anti-CMV and anti-HIV medications. Intravitreal ganciclovir injections may be the most cost effective strategy to treat CMV retinitis in these areas.

Keywords: AIDS; cytomegalovirus; immune recovery uveitis; retinal detachment; retinitis; treatment.

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Figures

Figure 1
Figure 1
Numerous cotton wool spots typical of HIV retinopathy.
Figure 2
Figure 2
Retinitis is progressing from top to bottom: solid line points to area of necrotic retina following retinitis; dashed line points to area of active retinitis; dotted line points to area of normal retina.
Figure 3
Figure 3
Intravitreal injection of ganciclovir through the pars plana.
Figure 4
Figure 4
Sustained-release ganciclovir implant sutured to the pars plana as seen through the pupil.
Figure 5
Figure 5
Diagram of the retina shows the three anatomic zones used for classification of CMV retinitis.
See this image and copyright information in PMC

References

    1. Kedhar SR, Jabs DA. Cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Herpes. 2007;14:66–71. - PubMed
    1. Staras SAS, Dollard SC, Radford KW, et al. Seroprevalence of cytomegalovirus infection in the United States, 1988–1994. Clin Infect Dis. 2006;43:1143–1151. - PubMed
    1. Drew WL, Mitz L, Miner RC, et al. Prevalence of cytomegalovirus infection in homosexual males. J Infect Dis. 1981;143:188–192. - PubMed
    1. Gallant JE, Moore RD, Richman DD, et al. Incidence and natural history of cytomegalovirus disease in patients with advanced human immunodeficiency virus disease treated with zidovudine. The Zidovudine Epidemiology Study Group. J Infect Dis. 1992;166:1223–1227. - PubMed
    1. Gottlieb MS, Schroff R, Schanker HM, et al. Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: Evidence of a new acquired cellular immunodeficiency. N Engl J Med. 1981;305:1425–1431. - PubMed