Indikation zur Augenuntersuchung von HIV-Patienten – Screening-Parameter für CMV-Retinitis

Gellrich, M M; Lagrèze, Wolf-D.; Rump, J. A.; Hansen, Lutz L.

doi:10.1055/s-2008-1035281

Cited by 5 publications

(4 citation statements)

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“…We strongly support Shi's assertion that retinal screening should be part of a standard initial evaluation for all individuals presenting with CD4 counts below 100 cells/μL, and we strongly agree about the importance of screening asymptomatic patients. This is consistent with previous evidence and recommendations [16]. …”

Section: Early Diagnosissupporting

confidence: 94%

CMV retinitis in China and SE Asia: the way forward

Heiden

Saranchuk

2011

BMC Infect Dis

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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.

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Section: Early Diagnosissupporting

confidence: 94%

CMV retinitis in China and SE Asia: the way forward

Heiden

Saranchuk

2011

BMC Infect Dis

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“…Clinical experience shows that limiting retinal examination only to patients with symptoms is not reliable, and that systematic retinal screening examination of vulnerable patients with or without symptoms is essential [26]. The efficacy of screening asymptomatic patients has been demonstrated [27], and meets generally accepted criteria for appropriate screening interventions: the disease is common, treatable, and easy to diagnose at an early stage, and the consequence of blindness is severe. Determination of visual acuity with an eye chart, the most commonly used eye screening test, measures only foveal function, representing less than 1% of the retinal surface, and is a poor test for CMV retinitis.…”

Section: Symptoms and The Need For Systematic Retinal Screeningmentioning

confidence: 99%

Cytomegalovirus Retinitis: The Neglected Disease of the AIDS Pandemic

Heiden¹,

Ford²,

Wilson³

et al. 2007

PLoS Med

115

144

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“… 3 Early diagnosis requires systematic screening of all patients with CD4+ T lymphocyte counts less than 100 cells/μL, because retinal damage may already be irreversible and extensive by the time the patient first reports symptoms. 5 Unfortunately, ophthalmological care is generally not available to HIV patients in resource-poor settings because of stigma associated with the disease and the logistical challenges of referring patients who are gravely ill. Ophthalmologists are often not available at all, or are not motivated or trained to treat HIV-related eye complications. Since ophthalmologists are traditionally the only clinicians trained in both indirect ophthalmoscopy and diagnosis of CMV retinitis, timely ophthalmic consultation for diagnosis of CMV retinitis in resource-poor settings is virtually never achieved.…”

Section: Introductionmentioning

confidence: 99%

Training clinicians treating HIV to diagnose cytomegalovirus retinitis

Heiden

Tun

Maningding

et al. 2014

Bull. World Health Organ.

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ProblemAcquired immunodeficiency syndrome (AIDS)-related cytomegalovirus (CMV) retinitis continues to be a neglected source of blindness in resource-poor settings. The main issue is lack of capacity to diagnose CMV retinitis in the clinical setting where patients receive care and all other opportunistic infections are diagnosed.ApproachWe developed and implemented a four-day workshop to train clinicians working in human immunodeficiency virus (HIV) clinics how to perform binocular indirect ophthalmoscopy and diagnose CMV retinitis. Workshops comprised both classroom didactic instruction and direct clinical eye examinations in patients with advanced AIDS. Between 2007 and 2013, 14 workshops were conducted in China, Myanmar and the Russian Federation.Local settingWorkshops were held with local clinicians at HIV clinics supported by nongovernmental organizations, public-sector municipal hospitals and provincial infectious disease referral hospitals. Each setting had limited or no access to locally- trained ophthalmologists, and an HIV-infected population with advanced disease.Relevant changesClinicians learnt how to do binocular indirect ophthalmoscopy and to diagnose CMV retinitis. One year after the workshop, 32/38 trainees in Myanmar did systematic eye examination for early diagnosis of CMV retinitis as standard care for at-risk patients. In China and the Russian Federation, the success rates were lower, with 10/15 and 3/5 trainees, respectively, providing follow-up data.Lessons learntSkills necessary for screening and diagnosis of CMV retinitis can be taught in a four-day task-oriented training workshop. Successful implementation depends on institutional support, ongoing training and technical support. The next challenge is to scale up this approach in other countries.

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Indikation zur Augenuntersuchung von HIV-Patienten – Screening-Parameter für CMV-Retinitis

Abstract: We recommend the following ophthalmological screening scheme for HIV-patients without ocular symptoms: (1) patients with a CD4+ count < 100 cells/microliters should be checked every third month and (2) those with a CD4+ count < 50 cells/microliters and CMV-uria every sixth week.

Cited by 5 publications

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CMV retinitis in China and SE Asia: the way forward

CMV retinitis in China and SE Asia: the way forward

Cytomegalovirus Retinitis: The Neglected Disease of the AIDS Pandemic

Training clinicians treating HIV to diagnose cytomegalovirus retinitis

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