Cytomegalovirus retinitis and HIV: Case reviews from KwaZulu-Natal Province, South Africa

Abstract

Background.Retinal cytomegalovirus (CMV) infection is a common opportunistic infection and remains a significant contributor to visual loss in patients with AIDS. We highlight the poor outcomes of CMV retinitis in three HIV-infected patients who were initiated on antiretroviral therapy (ART). We conducted a retrospective chart review of advanced stage HIV-infected patients with known CMV retinitis. Case 1. A 37-year-old man, with a CD4+ cell count of 35 cells/µL, presented for ART initiation with a 5-month history of visual loss in his left eye. Fundoscopy showed left eye CMV retinitis and right eye HIV retinopathy. ART and 5 months of weekly intravitreal ganciclovir injections (left eye) were commenced. Six-month outcomes included virological suppression, and visual acuity in the right eye of 6/6 and in the left eye of 3/60. Case 2. A 31-year-old woman, with a CD4+ cell count of 39 cells/µL and on tuberculosis therapy, presented for ART initiation. She presented with a 2-month history of decreased visual acuity. Fundoscopy showed bilateral CMV retinitis, which was more pronounced in the left eye. ART and 8 months of intravitreal ganciclovir injections were commenced. Six-month outcomes included virological suppression and visual acuity in the right eye of 6/9, and in the left eye of 6/24. Case 3. A 29-year-old woman, with a CD4+ cell count of 24 cells/µL, who was on tuberculosis therapy and ART, complained of blurred vision at her 2-month ART follow-up visit. Fundoscopy showed bilateral retinal detachment secondary to CMV retinitis. While silicone oil tamponade and subsequent retinectomy successfully repaired the right eye, extensive damage rendered the left eye irreparable. Six-month outcomes included virological suppression, with 6/120 visual acuity in the right eye and complete blindness in the left eye. Conclusion. CMV retinitis causes debilitating, permanent sequelae, which is preventable by ART initiation at higher CD4+ cell counts. Despite achieving virological suppression, vision could not be completely restored in these patients, irrespective of the severity of CMV retinitis. Med J 2017;107(10):843-846. DOI:10.7196/SAMJ.2017.v107i10.12740 S Afr 844October 2017, Vol. 107, No. 10 IN PRACTICEdirect damage to the macula or optic nerve, resulting in permanent blindness.[2] Blindness caused by CMV retinitis is irreversible and can occur prior to complete retinal destruction, which was responsible for >90% of HIV-associated blindness in the pre-ART era. [2] A total of 1 815 patients were enrolled into the PEPFAR-funded CAPRISA AIDS Treatment Programme (CAT) at the eThekwini site in Durban, South Africa (SA) between June 2004 and August 2013. In this report, we highlight the three patients in this cohort who developed CMV retinitis.Approval for data collection and analysis for the CAT programme was obtained from the University of KwaZulu-Natal Biomedical Research Ethics Committee (ref. no. E248/05). Case reports Case 1In June 2011, a 37-year-old man presented for ART initiation with a baseline CD4+ cell co...

Simultaneous Occurrence of Cytomegalovirus Colitis and Retinitis as the Initial Presentation of Human Immunodeficiency Virus Infection in a Patient With Zero CD4 Count

“…The simultaneous occurrence of CMV colitis and retinitis as the initial presentation of HIV infection is extremely rare; hence, our case is unique in its presentation. In some cases, CMV colitis and retinitis were presented as the only manifestation of HIV infection [3][4][5]. The risk of CMV retinitis and colitis is the highest when CD4 counts are below 50 cells/mm3 and is rare with CD4+ counts of more than 100 cells/mm3 [8].…”

“…The main symptoms of retinitis are a decrease in visual acuity (67%), floaters (49%), and flashing lights (16%); in addition, ocular irritation may present. CMV retinitis happens to be a very slow and progressive disease in patients with advanced-stage HIV [5][6][7][8][9][10]. The disease is diagnosed by fundoscopy unlike other systemic manifestations of CMV, which require confirmation of the diagnosis by biopsy taken from the affected site.…”

“…CMV retinitis is commonly confused with HIV retinopathy; however, the latter fades and condenses over time while CMV retinitis progresses [ 5 ]. When left untreated, CMV retinitis can progress to retinal detachment with direct damage to the macula or optic nerve, resulting in permanent blindness [ 5 ].…”

“…CMV retinitis is commonly confused with HIV retinopathy; however, the latter fades and condenses over time while CMV retinitis progresses [ 5 ]. When left untreated, CMV retinitis can progress to retinal detachment with direct damage to the macula or optic nerve, resulting in permanent blindness [ 5 ]. Blindness caused by CMV retinitis is irreversible and can occur prior to complete retinal destruction, which was responsible for >90% of HIV-associated blindness in the pre-antiretroviral therapy (ART) era [ 6 ].…”

Factores socioeconómicos y clínicos asociados con infecciones oportunistas en pacientes con HIV afiliados al sistema de salud

“…Las infecciones oportunistas aumentan la discapacidad, la morbilidad y la mortalidad (42,66,(73)(74)(75)(76). Las infecciones oportunistas se han asociado con trastornos neurocognitivos, con el síndrome inflamatorio de reconstitución inmunitaria, y con limitaciones auditivas, orales y visuales (52,73,(77)(78)(79)(80). Dada la ausencia de datos sobre la discapacidad y la mortalidad causadas por las infecciones oportunistas en Colombia, estas consecuencias no se analizaron en este estudio, por lo que se sugiere incluirlas en posteriores análisis.…”