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HIGHLY ACTIVE ANTIRETROVIRAL THERAPY-ASSOCIATED REGRESSION OF CYTOMEGALOVIRUS RETINITIS: Long-Term Results in a Small Case Series

REED, J. BRIAN MD*; BRIGGS, JONATHAN W. MD*; McDONALD, J. CHRISTOPHER MD†; FREEMAN, WILLIAM R. MD‡; MORSE, LAWRENCE S. MD, PhD§

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Abstract

Purpose: To report the stability of acquired immunodeficiency syndrome (AIDS)-associated cytomegalovirus (CMV) retinitis lesions that have undergone regression in the absence of specific anti-CMV medications owing to highly active antiretroviral therapy (HAART)-generated immune recovery.

Methods: The initial examination revealed HAART-associated regression of CMV retinitis lesions in eight subjects at two institutions. Patients were monitored for recurrences of CMV activity. CD4+ T-lymphocyte counts and human immunodeficiency virus (HIV) loads were measured.

Results: All patients had positive initial responses to HAART with an average HIV load decrease of 2.26 log units (range 0.3–5.57). Mean CD4+ T-lymphocyte count at baseline was 45.6 (range 4–107) and increased by an average of 132.5 (range 7–266) within the first 2 to 4 months of HAART. Patients were observed for an average of 15.5 months (range 11–20 months). Six subjects had a vigorous and sustained response to therapy, achieving an average HIV load of 9,400 copies/mL (3.32 log10 decrease) and CD4+ T-lymphocyte count of 158.2 cells/μL. These patients had no CMV retinitis progression. By contrast, two others who attained an average log10 decrease of only 0.48 had modest and short-lived increases in the CD4+ T-lymphocyte count. These patients experienced reactivation of CMV retinitis after 5 and 7 months, respectively.

Conclusion: Regressed CMV retinitis may remain healed for long periods. However, failure of HAART to induce substantial decreases in HIV load may predict poor or unsustainable rises in the CD4+ T-lymphocyte count and presage recurrence of CMV retinitis. Vigilance in ophthalmic examinations is especially mandatory in these subjects.

© The Ophthalmic Communications Society, Inc.

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