Effect of Highly Active Antiretroviral Therapy on the Incidence of HIV-Related Cytomegalovirus Retinitis and Retinal Detachment

Abstract

Cytomegalovirus retinitis (CMVR) is the most common intraocular infection encountered in ophthalmic practices. To assess the impact of highly active antiretroviral therapy (HAART) on the incidence of CMVR and subsequent retinal detachments, a retrospective review of the HIV+ patients seen at a single university and community-based practice between 1992-1993 (group 1), before the advent of protease inhibitors, was compared with the data obtained from October 1996 to October 1997 (group 2) and October 1997-1998 (group 3), after the widespread use of HAART. The incidence of CMVR and retinal detachment rates for each group was calculated and compared. Twenty five (2.6%) of 974 HIV+ patients in group 1 developed CMVR. Of these, four patients developed retinal detachment (16%). Group 2 had a total of 1084 HIV+ patients, 18 (1.7%) of whom developed CMVR, which indicates a 35% decline of the incidence of CMV retinitis at our institution (p = 0.052, Odds ratio = 0.533, Confidence interval 0.28-1.01) and three patients (20%) developed retinal detachment. Only 1 patient (0.07%) of 1274 patients in group 3 developed CMVR, which represents a 99% reduction since 1993 (p = 0.0000000456). We conclude that the incidence of CMVR at this institution has decreased significantly with the recent use of HAART therapy. This effect may be related to the aggressive use of HAART and associated immune recovery in this population of AIDS patients. In this small series, however, the rate of retinal detachment appeared unchanged, but was only observed in those individuals who were not on HAART or who had just recently started.

Next-generation nanomaterials: advancing ocular anti-inflammatory drug therapy

“…A prime example of an infectious retinal inflammatory condition is CMVR, which is the predominant ocular opportunistic infection in AIDS patients and a leading cause of blindness [ 141 ]. During the initial phase of cytomegalovirus infection, viral DNA is introduced into the nuclei of uninfected retinal cells, instigating viral DNA transcription and the production of viral particles, thereby initiating an immune response [ 142 , 143 ]. This triggers retinal inflammation, characterized by yellow-white necrotic lesions interspersed with red hemorrhages along blood vessels, radiating from the posterior pole to the periphery.…”

Impact of highly active antiretroviral therapy on organ‐specific manifestations of HIV‐1 infection

“…The second most common infection of the retina was necrotizing retinitis, caused by varicella-zoster, and the third most common was retinochoroiditis, caused by T. gondii. In a large retrospective study, Jalali et al [96] observed a dramatic decrease in the incidence of CMV retinitis after the introduction of HAART, representing a 99% reduction since 1993. In addition, much longer remission duration from recurrent CMV retinitis has been reported after the introduction of HAART, and the minimal HIV-1 viral load reached after the initiation of HAART therapy appears to be more important in one retrospective study, because all the studies addressing discontinuation of maintenance therapy were based mainly on CD4 cell count [97].…”

HIV‐related morbidity and mortality in patients starting protease inhibitors in very advanced HIV disease (CD4 count of < 50 cells/µL): an analysis of 338 clinical events from a randomized clinical trial*

“…Observational studies conducted in the main industrialized countries have shown that HIV‐related morbidity and mortality decreased significantly approximately since 1996 as an effect of introduction of potent antiretroviral therapies [1]. This has been demonstrated both in terms of overall morbidity [2,3] and for different clinical manifestations of AIDS separately, such as cytomegalovirus (CMV) disease [4–6], bacterial pneumonia [7], mycobacterial infections [8], HIV‐related tumours [9,10], toxoplasma encephalitis and HIV‐associated dementia [11].…”