Clinical stabilisation of CMV retinitis in AIDS patients under HAART
I. Folz, S. Krieglsteiner, C. Rosenkranz, H. Gümbel, C. Ohrloff
Background: Cytomegalovirus (CMV) retinitis used to be a common and potentially sight-threatening complication in AIDS-patients. The present study analysed the course of the disease under HAART and if there was a difference between patients who had more than 100 CD4+ cells/m l or below at the time of diagnosis.
Objective and design: 54 eyes in 31 patients (age between 29 and 61 years, mean 41.6) were analysed after a follow-up between 26 and 60 months (average 45.4 months). The presence or absence of anti-retroviral therapy (ART), the CD4+ count at the time of diagnosis and recurrence and the difference between patients with high (CD4+>100/m l) and low (CD4+<100/m l) CD4+ levels and the longest time without relaps were evaluated.
Results: CMV retinitis was diagnosed at a median CD4+ count of 31.1 cells/m l (range 0 - 180). There were just 4 patients (7 eyes) who had at least 100 cells/m l when diagnosed, none of them did recur (time without relaps: 26 to 45 months, mean 38.3) after successful treatment. The second group of patients had less than 70 cells/m l (mean 18.2). Recurrences were diagnosed at a median CD4+ count of 41.6 cells/m l (range 2 - 140). The median period without recurrence in this group was 42.5 months (26 to 59 months). 16 patients did not have ART, 5 single and 4 double ART when CMV retinitis was diagnosed. 6 Patients were on triple therapy for less than three months with a median CD4+ count of 26.8 cells/m l. There were only 8 recurrences under triple therapy (CD4+ count 2 115 cells/m l).
Conclusion: Those patients with higher CD4+ counts did not have any relapses and do now have better visual acuity. The other group suffered form more recurrences and more further complications as retinal detachment and development of cataract. In contrast to statistics from the 1980´ all these patients (except for one who died from liver failure) are still alive with a median survival time of 45.2 months after diagnosis. Finally it is obvious that HAART does not only have a large influence on the patients´ general health but also on common complications as CMV retinitis, especially the number of relapses after successful treatment in patients with rising CD4+ cell counts and therefore better clinical stabilisation.
Johann Wolfgang Goethe University, Dpt. of Ophthalmology, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany