Highly active antiretroviral therapy-related immune recovery in AIDS patients with cytomegalovirus retinitis

J. Christopher Macdonald, Marietta P. Karavellas, Francesca J. Torriani, Lawrence S Morse, Irene L. Smith, J. Brian Reed, William R. Freeman

Research output: Contribution to journalArticle

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Abstract

Objective: To characterize cytomegalovirus (CMV) retinitis in human immunodeficiency virus (HIV)-infected patients who demonstrate immune recovery while receiving highly active antiretroviral therapy (HAART). Design: Consecutive, noncomparative case series. Participants: Twenty-two HIV-positive patients, from two institutions, with a history of CMV retinitis, and with elevated CD4 cell counts after HAART. Main Outcome Measures: Duration of healed CMV retinitis without anti-CMV therapy, CD4 cell count, and HIV viral load. Intervention: Discontinuation of anti-CMV therapy after persistent elevation of CD4 cell count over 50 cell/mm3 (median, 161/mm3; range, 85-408/mm3). Results: The median period of healed CMV retinitis without anti-CMV therapy was 72 weeks (range, 33-116 weeks). Nineteen of 22 patients were still healed without anti-CMV therapy at study end. The three patients with CMV retinitis progression simultaneously had HAART, fail with CD4 cell counts of 37, 35, and 47/mm3. Conclusions: HIV-positive patients with CMV retinitis, who demonstrate a sustained HAART-induced elevation of CD4 cell count on two consecutive counts 3 months apart and whose retinitis remains healed on anti-CMV therapy for greater than 4 months, are likely to remain healed if the anti-CMV therapy is withdrawn. It is important to monitor these patients with indirect ophthalmoscopy because HAART failure may occur and allow CMV retinitis reactivation. (C) 2000 by the American Academy of Ophthalmology.

Original languageEnglish (US)
Pages (from-to)877-883
Number of pages7
JournalOphthalmology
Volume107
Issue number5
DOIs
StatePublished - 2000

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Cytomegalovirus Retinitis
Highly Active Antiretroviral Therapy
Cytomegalovirus
Acquired Immunodeficiency Syndrome
CD4 Lymphocyte Count
HIV
Therapeutics
Retinitis
Ophthalmoscopy
Viral Load
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Macdonald, J. C., Karavellas, M. P., Torriani, F. J., Morse, L. S., Smith, I. L., Reed, J. B., & Freeman, W. R. (2000). Highly active antiretroviral therapy-related immune recovery in AIDS patients with cytomegalovirus retinitis. Ophthalmology, 107(5), 877-883. https://doi.org/10.1016/S0161-6420(00)00023-3

Highly active antiretroviral therapy-related immune recovery in AIDS patients with cytomegalovirus retinitis. / Macdonald, J. Christopher; Karavellas, Marietta P.; Torriani, Francesca J.; Morse, Lawrence S; Smith, Irene L.; Reed, J. Brian; Freeman, William R.

In: Ophthalmology, Vol. 107, No. 5, 2000, p. 877-883.

Research output: Contribution to journalArticle

Macdonald, JC, Karavellas, MP, Torriani, FJ, Morse, LS, Smith, IL, Reed, JB & Freeman, WR 2000, 'Highly active antiretroviral therapy-related immune recovery in AIDS patients with cytomegalovirus retinitis', Ophthalmology, vol. 107, no. 5, pp. 877-883. https://doi.org/10.1016/S0161-6420(00)00023-3
Macdonald, J. Christopher ; Karavellas, Marietta P. ; Torriani, Francesca J. ; Morse, Lawrence S ; Smith, Irene L. ; Reed, J. Brian ; Freeman, William R. / Highly active antiretroviral therapy-related immune recovery in AIDS patients with cytomegalovirus retinitis. In: Ophthalmology. 2000 ; Vol. 107, No. 5. pp. 877-883.
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AU - Morse, Lawrence S

AU - Smith, Irene L.

AU - Reed, J. Brian

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N2 - Objective: To characterize cytomegalovirus (CMV) retinitis in human immunodeficiency virus (HIV)-infected patients who demonstrate immune recovery while receiving highly active antiretroviral therapy (HAART). Design: Consecutive, noncomparative case series. Participants: Twenty-two HIV-positive patients, from two institutions, with a history of CMV retinitis, and with elevated CD4 cell counts after HAART. Main Outcome Measures: Duration of healed CMV retinitis without anti-CMV therapy, CD4 cell count, and HIV viral load. Intervention: Discontinuation of anti-CMV therapy after persistent elevation of CD4 cell count over 50 cell/mm3 (median, 161/mm3; range, 85-408/mm3). Results: The median period of healed CMV retinitis without anti-CMV therapy was 72 weeks (range, 33-116 weeks). Nineteen of 22 patients were still healed without anti-CMV therapy at study end. The three patients with CMV retinitis progression simultaneously had HAART, fail with CD4 cell counts of 37, 35, and 47/mm3. Conclusions: HIV-positive patients with CMV retinitis, who demonstrate a sustained HAART-induced elevation of CD4 cell count on two consecutive counts 3 months apart and whose retinitis remains healed on anti-CMV therapy for greater than 4 months, are likely to remain healed if the anti-CMV therapy is withdrawn. It is important to monitor these patients with indirect ophthalmoscopy because HAART failure may occur and allow CMV retinitis reactivation. (C) 2000 by the American Academy of Ophthalmology.

AB - Objective: To characterize cytomegalovirus (CMV) retinitis in human immunodeficiency virus (HIV)-infected patients who demonstrate immune recovery while receiving highly active antiretroviral therapy (HAART). Design: Consecutive, noncomparative case series. Participants: Twenty-two HIV-positive patients, from two institutions, with a history of CMV retinitis, and with elevated CD4 cell counts after HAART. Main Outcome Measures: Duration of healed CMV retinitis without anti-CMV therapy, CD4 cell count, and HIV viral load. Intervention: Discontinuation of anti-CMV therapy after persistent elevation of CD4 cell count over 50 cell/mm3 (median, 161/mm3; range, 85-408/mm3). Results: The median period of healed CMV retinitis without anti-CMV therapy was 72 weeks (range, 33-116 weeks). Nineteen of 22 patients were still healed without anti-CMV therapy at study end. The three patients with CMV retinitis progression simultaneously had HAART, fail with CD4 cell counts of 37, 35, and 47/mm3. Conclusions: HIV-positive patients with CMV retinitis, who demonstrate a sustained HAART-induced elevation of CD4 cell count on two consecutive counts 3 months apart and whose retinitis remains healed on anti-CMV therapy for greater than 4 months, are likely to remain healed if the anti-CMV therapy is withdrawn. It is important to monitor these patients with indirect ophthalmoscopy because HAART failure may occur and allow CMV retinitis reactivation. (C) 2000 by the American Academy of Ophthalmology.

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