Incidence of Cytomegalovirus Retinitis in the Era of Highly Active Antiretroviral Therapy

To estimate the incidence of cytomegalovirus (CMV) retinitis in the era of highly active antiretroviral therapy (HAART) and to characterize the factors associated with increased risk of CMV retinitis. Prospective cohort study. A total of 1600 participants with acquired immunodeficiency syndrome (AID...

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Veröffentlicht in:American journal of ophthalmology Jg. 153; H. 6; S. 1016 - 1024.e5
Hauptverfasser: Sugar, Elizabeth A., Jabs, Douglas A., Ahuja, Alka, Thorne, Jennifer E., Danis, Ronald P., Meinert, Curtis L.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: New York, NY Elsevier Inc 01.06.2012
Elsevier
Elsevier Limited
Schlagworte:
Acquired immune deficiency syndrome
Adult
AIDS
AIDS-Related Opportunistic Infections - drug therapy
AIDS-Related Opportunistic Infections - epidemiology
Antiretroviral drugs
Antiretroviral Therapy, Highly Active
Biological and medical sciences
CD4 Lymphocyte Count
CD4-Positive T-Lymphocytes - immunology
Cohort Studies
Confidence intervals
Cytomegalovirus Retinitis - drug therapy
Cytomegalovirus Retinitis - epidemiology
Epidemiology
Female
HIV
Human immunodeficiency virus
Human viral diseases
Humans
Incidence
Infectious diseases
Lymphocytes
Male
Medical sciences
Middle Aged
Miscellaneous
Ophthalmology
Prospective Studies
Risk Factors
Studies
United States - epidemiology
Viral diseases
Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye
United States
Infection
Eye disease
Chemotherapy
Treatment
Viral disease
Antiviral
Cytomegalovirus retinitis
Ophthalmology
Incidence
ISSN:0002-9394, 1879-1891, 1879-1891
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Zusammenfassung:To estimate the incidence of cytomegalovirus (CMV) retinitis in the era of highly active antiretroviral therapy (HAART) and to characterize the factors associated with increased risk of CMV retinitis. Prospective cohort study. A total of 1600 participants with acquired immunodeficiency syndrome (AIDS) but without CMV retinitis at enrollment who completed at least 1 follow-up visit in the Longitudinal Study of the Ocular Complications of AIDS (LSOCA) were seen every 6 months to obtain disease and treatment history, ophthalmic examination, and laboratory testing. Incidence of CMV retinitis and risk factors for incident CMV retinitis were assessed. The incidence rate of CMV retinitis in individuals with AIDS was 0.36/100 person-years (PY) based upon 29 incident cases during 8134 PY of follow-up. The rate was higher for those with a CD4+ T cell count at the immediately prior visit below 50 cells/μL (3.89/100 PY, P < .01), whereas only 1 individual with a CD4+ T cell count of 50 to 99 cells/μL and 2 individuals with a CD4+ T cell count >100 cells/μL developed CMV retinitis. Having a CD4+ T cell count below 50 cells/μL at the clinical visit prior to CMV retinitis evaluation was the single most important risk factor (HR: 136, 95% CI: 30 to 605, P < .0001) for developing retinitis. Patients with AIDS, especially those with severely compromised immune systems, remain at risk for developing CMV retinitis in the HAART era, although the incidence rate is reduced from that observed in the pre-HAART era.
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Members of the SOCA Research Group are available as Supplemental Material.
Reprints: Douglas A. Jabs, SOCA Chairman’s Office, Department of Ophthalmology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1183, New York, NY 10029-6574; douglas.jabs@mssm.edu.
ISSN:0002-9394
1879-1891
1879-1891
DOI:10.1016/j.ajo.2011.11.014