CMV retinitis in China and SE Asia: the way forward

Abstract

AIDS-related CMV retinitis is a common clinical problem in patients with advanced HIV/AIDS in China and Southeast Asia. The disease is causing blindness, and current clinical management, commonly characterized by delayed diagnosis and inadequate treatment, results in poor clinical outcomes: 21% - 36% of eyes with CMV retinitis are already blind at the time the diagnosis is first established by an ophthalmologist. CMV retinitis also identifies a group of patients at extraordinary risk of mortality, and the direct or indirect contribution of extra-ocular CMV disease to AIDS-related morbidity and mortality is currently unmeasured and clinically often overlooked. The obvious way to improve clinical management of CMV retinitis is to screen all patients with CD4 counts < 100 cells/μL with indirect ophthalmoscopy at the time they first present for care, and to provide systemic treatment with oral valganciclovir when active CMV retinitis is detected. Treatment of opportunistic infections is an integral part of HIV management, and, with appropriate training and support, CMV retinitis screening and treatment can be managed by the HIV clinicians, like all other opportunistic infections. Access to ophthalmologist has been problematic for HIV patients in China, and although non-ophthalmologists can perform screening, sophisticated ophthalmological skills are required for the management of retinal detachment and immune recovery uveitis, the major complications of CMV retinitis. CMV retinitis has been clinically ignored, in part, because of the perceived complexity and expense of treatment, and this obstacle can be removed by making valganciclovir affordable and widely available. Valganciclovir is an essential drug for developing successful programs for management of CMV retinitis in China and throughout SE Asia.

Risk factors for CMV retinitis among individuals with HIV and low CD4 count in northern Thailand: importance of access to healthcare

“…CMV retinitis is often asymptomatic at its onset, so screening for this condition is important. Experts generally recommend that patients with HIV with a CD4 count below 100 cells/μL be examined with indirect ophthalmoscopy, but screening examinations are rarely done in resource-limited settings where the disease burden is highest 1 8. Given these realities, identifying risk factors for CMV retinitis could help public health officials, HIV doctors and ophthalmologists better understand the populations for which screening examinations would have the highest yield.…”

Prevalence and predictors of cytomegalovirus retinitis in HIV-infected patients with low CD4 lymphocyte counts in Vietnam

“…This would support calls for universal eye examination of patients with low CD4 counts <100 cells/mm 3 as the only method to ensure early detection and treatment of this sight-threatening disease. 2,17,18 In Vietnam, as in most other developing countries, the expertise in diagnosing CMV retinitis is limited to a few trained ophthalmologists in the largest cities. More training is needed for ophthalmologists in smaller cities and rural areas to accurately screen for CMV retinitis, which can be done without the need for expensive machinery or laboratory testing.…”

“…17 Experts now recommend that all patients in East and Southeast Asia with CD4 <100 cells/mm 3 be screened with retinal examination, but in practice it is rarely done. 17,18…”

Ocular infection with cytomegalovirus in Thailand: the clinical features, treatments and outcomes

“…[5][6][7] These diseases vary in severity, from spontaneously resolved to severe visual impairment if the patients were not treated promptly and properly. [8][9][10][11][12][13][14][15] Our interest was in the variation of clinical features of ocular CMV infection, therefore the main objective of our study was to report the characteristics of the patients, symptoms, clinical manifestations, treatments and outcomes of this viral infection. From the best of our knowledge, there was no article studying various ocular CMV diseases in both immunocompromised and immunocompetent patients.…”