A 17-year-old patient with hemophilia A was diagnosed with transfusion-acquired human immunodeficiency virus (HIV) infection in 1987. Antiretroviral therapy for diminishing CD4 cell counts included zidovudine for 3 years followed by didanosine and lamivudine (known then as 3TC). An initial ophthalmic screening examination in December 1992 revealed visual acuity of 20/20 in each eye, and retinal examination showed several nerve fiber layer infarcts (cotton-wool spots) in the left eye. In November 1993 the patient had no visual complaints, but on routine eye examination, visual acuity was 20/32 in the right eye and 20/25 in the left eye. Retinal examination revealed bilateral cytomegalovirus (CMV) retinitis (Figure), and the patient was started on intravenous ganciclovir at a dose of 5 mg/kg twice daily. Other medications included rifabutin (150 mg daily), captopril (12.5 mg twice a day), digoxin (0.37 mg daily), megestrol acetate (40 mg three times a day), lamivudine (175
Whitcup SM. Ocular Manifestations of AIDS. JAMA. 1996;275(2):142–144. doi:10.1001/jama.1996.03530260056031
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