Author Affiliation: Clinical Branch, National Eye Institute, National Institutes of Health, Bethesda, Md. Dr Whitcup is now with Allergan, Inc, Irvine, Calif.
Grand Rounds at the Clinical Center of the National
Institutes of Health Section Editors: John I. Gallin, MD, the Clinical
Center of the National Institutes of Health, Bethesda, Md; David S. Cooper,
MD, Contributing Editor, JAMA.
A number of striking changes have occurred recently in the presentation
and course of cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency
syndrome (AIDS) who are receiving highly active antiretroviral therapy (HAART).
Before the use of HAART, CMV retinitis was the most common intraocular infection
in patients with AIDS, occurring in up to 40% of patients, typically when
CD4+ cell counts have decreased to less than 0.10 × 109/L. By studying CMV retinitis, clinicians can investigate whether the
rejuvenated immune system that results from HAART can effectively control
opportunistic infections in patients with AIDS. In some patients, retinitis
has not progressed when specific anti-CMV therapy was discontinued, but a
number of patients have developed substantial intraocular inflammation, which
has resulted in decreased visual acuity. Anterior uveitis, cataract, vitritis,
cystoid macular edema, epiretinal membrane, and disc edema may occur in patients
with CMV retinitis who have experienced HAART-associated elevation in CD4+ cell counts. Since immune recovery uveitis does not occur in eyes
without CMV retinitis, the ocular inflammation appears to be related to the
CMV infection. Anti-CMV maintenance therapy likely can be safely discontinued
in some patients with CMV retinitis if CD4+ cell counts are stable
or increasing and have been higher than 0.10 × 109/L for
at least 3 months. Immune recovery in patients receiving HAART has been effective
in controlling opportunistic infections, but it may also result in intraocular
inflammation, which can have adverse effects on the eye.
Whitcup SM. Cytomegalovirus Retinitis in the Era of Highly Active Antiretroviral Therapy. JAMA. 2000;283(5):653-657. doi:10.1001/jama.283.5.653