TY - JOUR
T1 - Course of cytomegalovirus retinitis in the era of highly active antiretroviral therapy
T2 - Five-year outcomes
AU - Jabs, Douglas A.
AU - Ahuja, Alka
AU - Van Natta, Mark
AU - Lyon, Alice
AU - Srivastava, Sunil
AU - Gangaputra, Sapna
N1 - Funding Information:
Supported by cooperative agreements from the National Eye Institute , the National Institutes of Health , Bethesda, Maryland, to the Mount Sinai School of Medicine, New York, New York ( U10 EY08052 ); the Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland ( U10 EY08057 ); and the University of Wisconsin , Madison, Madison, Wisconsin ( U10 EY08067 ).
PY - 2010/11
Y1 - 2010/11
N2 - Purpose: To describe the 5-year outcomes of patients with cytomegalovirus (CMV) retinitis and AIDS in the era of highly active antiretroviral therapy (HAART). Design: Prospective, multicenter, observational study. Participants: A total of 503 patients with AIDS and CMV retinitis. Methods: Follow-up every 3 months with medical history, ophthalmologic examination, laboratory testing, and retinal photographs. Participants were classified as having previously diagnosed CMV retinitis and immune recovery (CD4+ T cells <100 cells/μl), previously diagnosed retinitis and immune compromise, and newly diagnosed CMV retinitis (diagnosis <45 days before enrollment). Main Outcome Measures: Mortality, retinitis progression (movement of the border of a CMV lesion < disc diameter or occurrence of a new lesion), retinal detachment, immune recovery uveitis (IRU), and visual loss (<20/40 and <20/200). Results: Overall mortality was 9.8 deaths/100 person-years (PY). Rates varied by group at enrollment from 3.0/100 PY for those with previously diagnosed retinitis and immune recovery to 26.1/100 PY for those with newly diagnosed retinitis. The rate of retinitis progression was 7.0/100 PY and varied from 1.4/100 PY for those with previously diagnosed retinitis and immune recovery to 28.0/100 PY for those with newly diagnosed retinitis. The rate of retinal detachment was 2.3/100 eye-years (EY) and varied from 1.2/100 EY for those with previously diagnosed retinitis and immune recovery to 4.9/100 EY for those with newly diagnosed retinitis. The rate of IRU was 1.7/100 PY and varied from 1.3/100 PY for those with previously diagnosed retinitis and immune recovery at enrollment to 3.6/100 PY for those with newly diagnosed retinitis who subsequently experienced immune recovery. The rates of visual loss to <20/40 and to ≤20/200 were 7.9/100 EY and 3.4/100 EY, respectively; they varied from 6.1/100 EY and 2.7/100 EY for those with previously diagnosed retinitis and immune recovery to 11.8/100 EY and 5.1/100 EY for those with newly diagnosed retinitis. Although the event rates tended to decline with time, in general, at no time did they reach zero. Conclusions: Despite the availability of HAART, patients with AIDS and CMV retinitis remain at increased risk for mortality, retinitis progression, complications of the retinitis, and visual loss over a 5-year period. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
AB - Purpose: To describe the 5-year outcomes of patients with cytomegalovirus (CMV) retinitis and AIDS in the era of highly active antiretroviral therapy (HAART). Design: Prospective, multicenter, observational study. Participants: A total of 503 patients with AIDS and CMV retinitis. Methods: Follow-up every 3 months with medical history, ophthalmologic examination, laboratory testing, and retinal photographs. Participants were classified as having previously diagnosed CMV retinitis and immune recovery (CD4+ T cells <100 cells/μl), previously diagnosed retinitis and immune compromise, and newly diagnosed CMV retinitis (diagnosis <45 days before enrollment). Main Outcome Measures: Mortality, retinitis progression (movement of the border of a CMV lesion < disc diameter or occurrence of a new lesion), retinal detachment, immune recovery uveitis (IRU), and visual loss (<20/40 and <20/200). Results: Overall mortality was 9.8 deaths/100 person-years (PY). Rates varied by group at enrollment from 3.0/100 PY for those with previously diagnosed retinitis and immune recovery to 26.1/100 PY for those with newly diagnosed retinitis. The rate of retinitis progression was 7.0/100 PY and varied from 1.4/100 PY for those with previously diagnosed retinitis and immune recovery to 28.0/100 PY for those with newly diagnosed retinitis. The rate of retinal detachment was 2.3/100 eye-years (EY) and varied from 1.2/100 EY for those with previously diagnosed retinitis and immune recovery to 4.9/100 EY for those with newly diagnosed retinitis. The rate of IRU was 1.7/100 PY and varied from 1.3/100 PY for those with previously diagnosed retinitis and immune recovery at enrollment to 3.6/100 PY for those with newly diagnosed retinitis who subsequently experienced immune recovery. The rates of visual loss to <20/40 and to ≤20/200 were 7.9/100 EY and 3.4/100 EY, respectively; they varied from 6.1/100 EY and 2.7/100 EY for those with previously diagnosed retinitis and immune recovery to 11.8/100 EY and 5.1/100 EY for those with newly diagnosed retinitis. Although the event rates tended to decline with time, in general, at no time did they reach zero. Conclusions: Despite the availability of HAART, patients with AIDS and CMV retinitis remain at increased risk for mortality, retinitis progression, complications of the retinitis, and visual loss over a 5-year period. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
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U2 - 10.1016/j.ophtha.2010.03.031
DO - 10.1016/j.ophtha.2010.03.031
M3 - Article
C2 - 20673591
AN - SCOPUS:78049242404
SN - 0161-6420
VL - 117
SP - 2152-2161.e2
JO - Ophthalmology
JF - Ophthalmology
IS - 11
ER -