Clinical features and outcomes of AIDS-related cytomegalovirus retinitis in the era of highly active antiretroviral therapy.

Purpose: To describe the features and outcomes of patients with AIDS-related cytomegalovirus retinitis after highly active antiretroviral therapy availability.

Methods: Retrospective chart review of 30 consecutive patients (44 eyes) with AIDS and newly diagnosed, active AIDS-related cytomegalovirus retinitis, examined from January 2005 to December 2007.

Results: The mean age was 34.8 years, 18 patients (60.0%) were male and median duration of AIDS was 90 months. Nineteen patients (63.3%) had evidence of highly active antiretroviral therapy failure and median CD4+ lymphocyte count was 12.5 cells/microl. Visual acuity at presentation was 20/40 or better in 27 eyes (61.4%). Retinitis involved Zone 1 in 13 eyes (39.5%). Despite specific anti-AIDS-related cytomegalovirus therapy, 16 eyes (36.4%) presented relapse of retinitis and 10 eyes (22.7%) lost at least three lines of vision. When compared to highly active antiretroviral therapy responsive patients, eyes of highly active antiretroviral therapy failure patients were more likely to develop relapse of retinitis (p=0.03) and loss of at least three lines of vision (p=0.03).

Conclusion: The patients in this series are essentially young men with longstanding AIDS, non-responsive to highly active antiretroviral therapy and with a similar immunological profile as noted before highly active antiretroviral therapy era. These findings have implications for the management of the disease and confirm the magnitude of rational periodic screening after diagnosis of AIDS.