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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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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.

*Wilford Hall Medical Center, Lackland AFB, Texas; †University of Texas San Antonio; ‡University of California San Diego; §University of California Davis.

Reprint requests: J. Brian Reed, MD, Department of Ophthalmology, Wilford Hall Medical Center, Lackland AFB, TX 78236-5300; e-mail: john.reed@59mdw.whmc.af.mil

Supported by NIH grant EY07366.

None of the authors has a proprietary interest in any of the drugs or products mentioned in this article. The views are the authors’ and do not reflect the official policy of the Department of Defense or any other agency of the United States government.

© The Ophthalmic Communications Society, Inc.