Monitoring Cytomegalovirus Retinitis Prevalence in an HIV-Seropositive Cohort: The Assessment of Improvements Observed following the Introduction of Highly Active Antiretroviral Triple Therapy

Abstract

This paper concerns the ophthalmic assessment of patients with acquired immunodeficiency syndrome (AIDS) for a number of eye conditions and in particular cytomegalovirus (CMV) retinitis. CMV has been the most common opportunistic infection associated with AIDS and the leading cause of blindness among AIDS patients. There have been early indications of a widespread fall in CMV prevalence internationally following the introduction of a new highly active antiretroviral triple (HAART) therapy. Our study sought to assess the position for Ireland. Our cohort was the entire population of stage IV AIDS patients attending the country's leading referral centre. The total number of patients examined was 167 and the period of examination was 1 May 1995 to 30 April 1997. HAART was introduced in March 1996, so the data permitted a 'before and after' comparison of various clinical findings. The incidence of new CMV cases was found to be 4 among the 102 patients examined in the first 12-month period and one among 107 patients examined in the second 12-month period. There were accompanying declines in HIV-related noninfectious retinal vasculopathy (HIVR), keratitis and other conditions. The findings are promising, but we argue that caution is needed in assessing long-term trends. In the paper we discuss a number of methodological issues in the collection and analysis of the clinical data and in the interpretation of results.

Ocular association of HIV infection in the era of highly active antiretroviral therapy and the global perspective

“…Prior to the introduction of HAART, CMV retinitis (Fig. 1) affected 30–40% of HIV‐infected patients eventually 44 . CMV retinitis is a predictor of severe HIV infection and the post‐diagnosis median survival was 0.65 years prior to 1995.…”

“…The features include cotton wool spots, intraretinal haemorrhages and microaneurysms, particularly around the posterior pole. The introduction of HAART has produced a significant decline in its incidence 44,129 . Reduction in macular leukocyte velocity, caused by an increased cellular rigidity was postulated to be a contributory aetiology 130,131 .…”