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Changes in the natural history of cytomegalovirus retinitis following the introduction of highly active antiretroviral therapy

Deayton, Jane Ra; Wilson, Paulineb; Sabin, Caroline Ac; Davey, Clare Cb; Johnson, Margaret Ad; Emery, Vincent Ca; Griffiths, Paul Da

Clinical

Objective: To determine the effect of highly active antiretroviral therapy (HAART) on the natural history of cytomegalovirus (CMV) retinitis.

Design and participants: Retrospective analysis of 103 consecutive patients diagnosed with CMV retinitis between 1990 and 1998.

Setting: Specialist HIV medicine department of a London hospital.

Main outcome measures: Incidence of CMV retinitis, time to death following diagnosis, episodes of progression, incidence of inflammatory complications. The date of first use of HAART was January 1995. Data were censored on 30 June 1998.

Results: The incidence of CMV retinitis has declined dramatically following the introduction of HAART. Survival following CMV retinitis increased from a median of 0.65 years prior to 1995 to a median of 1.07 years after this date (P  = 0.004). In multivariate analyses HAART was independently associated with improved survival (P  = 0.02) and the association with year of diagnosis was no longer significant, suggesting that this effect is predominantly due to HAART. None of the patients receiving HAART experienced progression after 6 months of treatment. Complications of retinitis such as retinal detachment, uveitis and optic atrophy occurred in 39% of patients. The rare inflammatory complications of vitritis and cystoid macular oedema ocurred only in recipients of HAART.

Conclusions: The introduction of HAART has had a major impact on the natural history of CMV retinitis with improved survival time and decreased risk of progression following diagnosis. However, immune reconstitution may be associated with inflammatory complications which can result in significant visual loss in the absence of active CMV disease.

From the Departments of aVirology, bOphthalmology, cPrimary Care and Population Sciences and dThoracic/HIV Medicine, Royal Free Hampstead National Health Service Trust and Royal Free and University College School of Medicine, London, UK.

Received: 6 July 1999;

revised: 27 January 2000; accepted: 7 February 2000.

Sponsorship: Supported by Medical Research Council (MRC) Training Fellowship G84/5139 & Grant 1R01 AI41687-01 from the National Institutes of Health.

Correspondence to Dr J Deayton, MRC Research Fellow, Department of Virology, Royal Free and University College School of Medicine, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. Tel: 0207 830 2997/fax 0207 830 2854; e-mail: deayton@rfhsm.ac.uk

© 2000 Lippincott Williams & Wilkins, Inc.