Course of cytomegalovirus retinitis in the era of highly active antiretroviral therapy: five-year outcomes

Abstract

Purpose: To describe the 5-year outcomes of patients with cytomegalovirus (CMV) retinitis and AIDS in the era of highly active antiretroviral therapy (HAART).

Design: Prospective, multicenter, observational study.

Participants: A total of 503 patients with AIDS and CMV retinitis.

Methods: Follow-up every 3 months with medical history, ophthalmologic examination, laboratory testing, and retinal photographs. Participants were classified as having previously diagnosed CMV retinitis and immune recovery (CD4+ T cells ≥ 100 cells/μl), previously diagnosed retinitis and immune compromise, and newly diagnosed CMV retinitis (diagnosis <45 days before enrollment).

Main outcome measures: Mortality, retinitis progression (movement of the border of a CMV lesion ≥ ½ disc diameter or occurrence of a new lesion), retinal detachment, immune recovery uveitis (IRU), and visual loss (< 20/40 and ≥ 20/200).

Results: Overall mortality was 9.8 deaths/100 person-years (PY). Rates varied by group at enrollment from 3.0/100 PY for those with previously diagnosed retinitis and immune recovery to 26.1/100 PY for those with newly diagnosed retinitis. The rate of retinitis progression was 7.0/100 PY and varied from 1.4/100 PY for those with previously diagnosed retinitis and immune recovery to 28.0/100 PY for those with newly diagnosed retinitis. The rate of retinal detachment was 2.3/100 eye-years (EY) and varied from 1.2/100 EY for those with previously diagnosed retinitis and immune recovery to 4.9/100 EY for those with newly diagnosed retinitis. The rate of IRU was 1.7/100 PY and varied from 1.3/100 PY for those with previously diagnosed retinitis and immune recovery at enrollment to 3.6/100 PY for those with newly diagnosed retinitis who subsequently experienced immune recovery. The rates of visual loss to < 20/40 and to ≤ 20/200 were 7.9/100 EY and 3.4/100 EY, respectively; they varied from 6.1/100 EY and 2.7/100 EY for those with previously diagnosed retinitis and immune recovery to 11.8/100 EY and 5.1/100 EY for those with newly diagnosed retinitis. Although the event rates tended to decline with time, in general, at no time did they reach zero.

Conclusions: Despite the availability of HAART, patients with AIDS and CMV retinitis remain at increased risk for mortality, retinitis progression, complications of the retinitis, and visual loss over a 5-year period.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.

Figure 1

Mortality among patients with cytomegalovirus retinitis. CMV=cytomegalovirus.

Figure 2

a. Retinitis progression among patients with cytomegalovirus retinitis. b. Retinitis progression among patients with cytomegalovirus retinitis. CMV= cytomegalovirus.

Figure 2

a. Retinitis progression among patients with cytomegalovirus retinitis. b. Retinitis progression among patients with cytomegalovirus retinitis. CMV= cytomegalovirus.

Figure 3

Retinal detachment among patients with cytomegalovirus retinitis.

Figure 4

a. Immune recovery among patients with newly-diagnosed cytomegalovirus retinitis. CMV= cytomegalovirus. b. Immune recovery uveitis among patients with newly-diagnosed cytomegalovirus retinitis.

Figure 4

a. Immune recovery among patients with newly-diagnosed cytomegalovirus retinitis. CMV= cytomegalovirus. b. Immune recovery uveitis among patients with newly-diagnosed cytomegalovirus retinitis.

Figure 5

a. Visual loss to worse than 20/40 among patients with cytomegalovirus retinitis. CMV= cytomegalovirus. b. Visual loss to 20/200 or worse among patients with cytomegalovirus retinitis. CMV= cytomegalovirus.

Figure 5

a. Visual loss to worse than 20/40 among patients with cytomegalovirus retinitis. CMV= cytomegalovirus. b. Visual loss to 20/200 or worse among patients with cytomegalovirus retinitis. CMV= cytomegalovirus.