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Observational Study
. 2015 Jul;122(7):1452-63.
doi: 10.1016/j.ophtha.2015.02.033. Epub 2015 Apr 17.

Long-term Outcomes of Cytomegalovirus Retinitis in the Era of Modern Antiretroviral Therapy: Results from a United States Cohort

Douglas A Jabs  1 , Alka Ahuja  2 , Mark L Van Natta  2 , Alice T Lyon  3 , Steven Yeh  4 , Ronald Danis  5 ; Studies of the Ocular Complications of AIDS Research Group
Affiliations
Observational Study

Long-term Outcomes of Cytomegalovirus Retinitis in the Era of Modern Antiretroviral Therapy: Results from a United States Cohort

Douglas A Jabs et al. Ophthalmology. 2015 Jul.

Abstract

Purpose: To describe the long-term outcomes of patients with cytomegalovirus (CMV) retinitis and AIDS in the modern era of combination antiretroviral therapy.

Design: Prospective, observational cohort study.

Participants: Patients with AIDS and CMV retinitis.

Methods: Immune recovery, defined as a CD4+ T-cell count >100 cells/μl for ≥3 months.

Main outcome measures: Mortality, visual impairment (visual acuity <20/40), and blindness (visual acuity ≤20/200) on logarithmic visual acuity charts and loss of visual field on quantitative Goldmann perimetry.

Results: Patients without immune recovery had a mortality of 44.4/100 person-years (PYs) and a median survival of 13.5 months after the diagnosis of CMV retinitis, whereas those with immune recovery had a mortality of 2.7/100 PYs (P < 0.001) and an estimated median survival of 27.0 years after the diagnosis of CMV retinitis. The rates of bilateral visual impairment and blindness were 0.9 and 0.4/100 PYs, respectively, and were similar between those with and without immune recovery. Among those with immune recovery, the rate of visual field loss was approximately 1% of the normal field per year, whereas among those without immune recovery it was approximately 7% of the normal field per year.

Conclusions: Among persons with CMV retinitis and AIDS, if there is immune recovery, long-term survival is likely, whereas if there is no immune recovery, the mortality rate is substantial. Although higher than the rates in the population not infected by human immunodeficiency virus, the rates of bilateral visual impairment and blindness are low, especially when compared with rates in the era before modern antiretroviral therapy.

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Figures

Figure 1
Figure 1
Mean CD4+ T cells among patients with immune recovery after immune recovery. Bars represent 95% confidence intervals.
Figure 2
Figure 2
Kaplan Meier estimates of survival of patients with AIDS and cytomegalovirus retinitis after the diagnosis of cytomegalovirus retinitis, for patients with and without immune recovery. Shaded areas represent 95% confidence intervals.
Figure 3
Figure 3
Cumulative probability of: a) bilateral visual impairment (worse than 20/40); and b) bilateral blindness (20/200 or worse) among patients with cytomegalovirus retinitis after the diagnosis of cytomegalovirus retinitis. Shaded areas represent 95% confidence intervals.
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