2002
Ocular Microbiology and Immunology Group, Abstract 18
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HAART-Mediated
Long-term Cytomegalovirus Retinitis Quiescence
Robert J. Campbell, MD MSc, Elizabeth C. Lowcock, William G. Hodge,
MD MPH FRCSC
University of Ottawa Eye Institute, Ottawa Ontario Canada
Purpose:
To describe the long-term quiescence of cytomegalovirus (CMV) retinitis
among patients for whom highly-active antiretroviral therapy (HAART)-mediated
immune system reconstitution has enabled discontinuation of specific
anti-CMV therapy.
Methods:
A prospective cohort study was undertaken. All patients with Acquired
Immunodeficiency Syndrome (AIDS) diagnosed with CMV retinitis between
January 1996 and July 2002 at the University of Ottawa Eye Institute,
Ottawa, Canada were enrolled. For all patients receiving HAART,
duration of specific anti-CMV therapy and disease-free follow up
after cessation of anti-CMV therapy were calculated. Because most
patients had been treated with weekly intraocular injections, the
specific time point of anti-CMV cessation can be determined precisely.
Results:
7 patients receiving HAART demonstrated immune system recovery and
subsequently discontinued specific anti-CMV therapy after a mean
treatment period of 1.8 years. At the time of discontinuation, mean
CD4+ T-cell count had risen to 276/ µL. Mean follow-up after
discontinuation of specific anti-CMV therapy was 3.1 years (range:
2.0 to 4.8 years). During this time, none of the subjects experienced
retinitis progression or reactivation. Conclusions: As is well known,
HAART has revolutionized the treatment and prognosis of CMV retinitis.
Our data demonstrate that at this point in the AIDS epidemic, CMV
retinitis may remain quiescent without specific anti-CMV therapy
for periods extending close to five years in patients receiving
HAART.
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