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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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