Long-term Outcomes of Cytomegalovirus Retinitis in the Era of Modern Antiretroviral Therapy: Results from a United States Cohort

Ophthalmology. 2015 Jul;122(7):1452-63. doi: 10.1016/j.ophtha.2015.02.033. Epub 2015 Apr 17.

Abstract

Purpose: To describe the long-term outcomes of patients with cytomegalovirus (CMV) retinitis and AIDS in the modern era of combination antiretroviral therapy.

Design: Prospective, observational cohort study.

Participants: Patients with AIDS and CMV retinitis.

Methods: Immune recovery, defined as a CD4+ T-cell count >100 cells/μl for ≥3 months.

Main outcome measures: Mortality, visual impairment (visual acuity <20/40), and blindness (visual acuity ≤20/200) on logarithmic visual acuity charts and loss of visual field on quantitative Goldmann perimetry.

Results: Patients without immune recovery had a mortality of 44.4/100 person-years (PYs) and a median survival of 13.5 months after the diagnosis of CMV retinitis, whereas those with immune recovery had a mortality of 2.7/100 PYs (P < 0.001) and an estimated median survival of 27.0 years after the diagnosis of CMV retinitis. The rates of bilateral visual impairment and blindness were 0.9 and 0.4/100 PYs, respectively, and were similar between those with and without immune recovery. Among those with immune recovery, the rate of visual field loss was approximately 1% of the normal field per year, whereas among those without immune recovery it was approximately 7% of the normal field per year.

Conclusions: Among persons with CMV retinitis and AIDS, if there is immune recovery, long-term survival is likely, whereas if there is no immune recovery, the mortality rate is substantial. Although higher than the rates in the population not infected by human immunodeficiency virus, the rates of bilateral visual impairment and blindness are low, especially when compared with rates in the era before modern antiretroviral therapy.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy*
  • AIDS-Related Opportunistic Infections / immunology
  • AIDS-Related Opportunistic Infections / mortality
  • Adult
  • Antiviral Agents / therapeutic use*
  • Blindness / epidemiology
  • CD4 Lymphocyte Count
  • CD4-Positive T-Lymphocytes / immunology
  • Cytomegalovirus Retinitis / drug therapy*
  • Cytomegalovirus Retinitis / immunology
  • Cytomegalovirus Retinitis / mortality
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Survival Rate
  • Treatment Outcome
  • United States / epidemiology
  • Visual Acuity / physiology
  • Visual Field Tests
  • Visual Fields / physiology
  • Visually Impaired Persons / statistics & numerical data

Substances

  • Antiviral Agents