Cytomegalovirus Retinitis in HIV and Non-HIV Individuals

Abstract

Cytomegalovirus retinitis (CMVR) is a severe, vision-threatening disease that primarily affects immunosuppressed patients. CMVR is the most common ocular opportunistic infection in human immunodeficiency virus (HIV) infected patients and is the leading cause of blindness in this group; however, the incidence of CMVR in HIV patients has dramatically decreased with antiretroviral therapy. Other causes of immunosuppression, including organ transplantation, hematologic malignancies, and iatrogenic immunosuppression, can also lead to the development of CMVR. Herein, we describe the pathogenesis of CMVR and compare clinical features, epidemiology, and risk factors in HIV and non-HIV infected individuals with CMVR.

Do we need separate screening strategies for cytomegalovirus retinitis in different underlying immunosuppressed states? A retrospective study from Western India

“…For patients in zone 2 or 3, systemic therapy alone with close observation was followed. [ 4 ] Oral valganciclovir was preferred for systemic therapy. Intravenous ganciclovir therapy was given when patient was admitted at the oncology centre for intravenous chemotherapy or when the cost of treatment was a burden.…”

“…Individuals with acquired immunodeficiency syndrome (AIDS) from human immunodeficiency virus (HIV), malignancies, systemic immunosuppressive therapy, post-organ transplant, and primary immunodeficiency are at higher risk for developing CMV retinitis. [ 4 ] In patients of HIV infections, combination antiretroviral therapy (cART) has significantly reduced the occurrence of CMV retinitis among AIDS patients due to the improvement in blood counts. Despite that, CMV retinitis still remains the most common ocular opportunistic infection in patients with AIDS.…”

“…Patients with a CD4+ T cell count<50 cells/microliter continue to be at increased risk of CMV retinitis, and screening in this population is essential. [ 4 ] Amongst patients with non-HIV causes of immunosuppression, ophthalmologists have been witnessing an increasing number of eyes developing CMV retinitis because of more widespread use of improved immunosuppressive therapy for auto-immune diseases, organ transplants, and malignancies. [ 5 ] We are a tertiary referral ophthalmic centre based in western India, routinely screening immunosuppressed patients from the nodal cancer centre as well as the local human immunodeficiency virus (HIV) treatment clinic in the vicinity.…”

Human immunodeficiency virus and intraocular inflammation in the era of highly active anti retroviral therapy – An update

“…Genetic susceptibility characteristics such as specific haplotypes of interleukin 10 receptor (IL-10R1), chemokine receptor 5 (CCR5), and stromal- derived factor-1 (SDF-1) have been identified as possible risk factors. [ 48 ] Interestingly, HIV microangiopathy, with cotton wool spots (CWS), which are areas of retinal microinfarction, has also been found to be a risk factor, presumably by interrupting the blood-retinal barrier and thus facilitating the viral entry into the eye. [ 7 19 48 ] Although HAART does not completely prevent the occurrence of CMVR, it has contributed to the more rapid resolution of lesions without the need for long term maintenance therapy.…”

“…[ 92 ] CMVR in children is usually more aggressive, bilateral, has a predilection for the macula, and occurs only with much lower CD4 counts when compared to adults. [ 48 ] Since children may not complain even with advanced vision loss, frequent ophthalmic screening is a must for early detection and initiation of treatment.…”