Oral valganciclovir in human immunodeficiency virus-positive patients suffering from cytomegalovirus retinitis at a tertiary care hospital in North India

Purpose: To study clinical efficacy of valganciclovir in cytomegalovirus retinitis (CMVR) in human immunodeficiency virus (HIV)?positive?positive patients in a tertiary care clinic in a developing nation. Methods: In a retrospective study, systemic and ocular records of HIV patients suffering from CMVR and treated with valganciclovir, were analyzed. Primary outcome measures were involvement of the other eye, incidence of retinal detachment, systemic involvement, and mortality encountered. Secondary outcome measures included change in BCVA. Results: Out of nine patients who were included, two patients developed CMVR in the other eye and only one patient (11.11%) developed retinal detachment during the course of the study. No patient developed any systemic manifestations or had mortality during the course of the study. The change in BCVA was not statistically significant. Conclusion: Use of oral valganciclovir showed good outcome and was found to be a better alternative compared to the use of intravitreal ganciclovir in the literature. Introduction of valganciclovir at an affordable price in developing nations can decrease disease burden

Correlation of quantitative polymerase chain reaction with clinical characteristics of patients with viral retinitis

Purpose: To evaluate the correlation of quantitative real?time polymerase chain reaction (qRT?PCR) to the clinical characteristics of patients with viral retinitis.Methods: Retrospective case series. Results: Aqueous or vitreous samples of 20 out of 35 eyes showed qRT?PCR positivity for virus etiology (57.14%). Cytomegalovirus (CMV) was most commonly identified in nine eyes (45%). The mean DNA copy number was 2,68,339.65 copies/mL (range: 90–3205397). DNA copy number significantly correlated with the extent of clinical involvement (P = 0.013); however, there was no correlation between DNA copy number and presenting visual acuity (P = 0.31), macular involvement (P = 0.675), optic nerve involvement (P = 0.14), and development of retinal detachment (P = 0.73). There was a significant correlation between the number of DNA copies and the timing of sampling (P = 0.0005). Samples taken earlier in the course of the disease had higher viral copies than later ones. Conclusion: qRT?PCR is useful in confirming a viral etiology in over 50% of cases of suspected viral retinitis. It correlates well with the extent of clinical involvement and timing of sampling

Ocular manifestations in patients attending antiretroviral therapy centre at a tertiary care hospital in Himachal Pradesh, India

Background & objectives: Ocular manifestations in HIV/AIDS patients range from adnexal disorders to the posterior segment disease. This study was aimed to evaluate the ocular manifestations, including vision-threatening manifestations in HIV-positive patients attending an antiretroviral therapy centre (ART) of a tertiary care hospital in north India and its association with the CD4+ cell count. Methods: This cross-sectional study was conducted in the department of Ophthalmology in collaboration with the ART centre. An equal number of patients were selected from each year i.e., 30 patients each from those registered in the year 2010 till 2015. These patients were selected randomly from the register using systematic randomization. Hence, a total of 150 patients were examined for ocular manifestations. All the patients included in this study were on highly active ART. Results: Of the 150 patients examined, 53 per cent were females and 47 per cent were males. Heterosexual transmission was the most common mode of transmission in 126 (84%) patients. Maximum number of patients was in the age group of 31-40 yr. Ocular manifestations were present in 53 [35.3%; 95% confidence interval (CI): 28-43%] patients. Twelve (8%; 95% CI: 4-12%) patients had lid and adnexal manifestations. Anterior-segment manifestations were present in 20 (13.3%; 95% CI: 8-19%) patients. Posterior-segment manifestations were present in 21 (14%; 95% CI: 8-20%) and vision-threatening posterior-segment ocular lesions were present in 14 per cent of the patients. Univariate logistic regression showed a significant (P<0.001) inverse association of CD4+T-cell count with the vision-threatening posterior-segment ocular lesions. Interpretation & conclusions: Routine ocular examination may be done in all the HIV/AIDS patients to detect and treat vision-threatening ocular lesions at the earliest.

HIV- and AIDS-related Ocular Manifestations in Tanzanian Patients

Background: Although around 70% of HIV+ cases used to have ocular manifestations, the late reporting of cases often results in severe forms of ocular morbidity that would otherwise have been prevented. The objective of this study was to describe the ocular manifestations of HIV and AIDS-related patients who had been admitted to TM Jafferji Hospital, Dar-es-Salaam, Tanzania. Methods: Proven cases of HIV were recruited in this study. Detailed slit lamp examination and fundoscopy using a +90D lens were carried out in all cases after thoroughly dilating the pupil with 1% Tropicamide eye drops. Results: Around 90% of the recruited cases were in clinical stage III and IV HIV. The notable ocular manifestations included micro-vasculopathy of the retina in 25%, uveitis in 8%, CMV retinitis in 7%, neuro-ophthalmic manifestation in 6%, Herpes zoster ophthalmicus in 5%, Kaposi’s sarcoma in 3% and conjunctival carcinoma in 2% of cases. Fifty-three percent of the cases had other anterior segment disorders like conjunctivitis, blepharitis and corneal ulcers. Conclusion: Most of the cases recruited in our study were in the late stages of HIV. A significantly high number of cases (70%) had ocular manifestations. Around 53% had additional anterior segment disorders like conjunctivitis, blepharitis and corneal ulcers.

Withdrawal of maintenance therapy for cytomegalovirus retinitis in AIDS patients exhibiting immunological response to HAART

BACKGROUND: Before the introduction of highly active antiretroviral therapy (HAART), CMV retinitis was a common complication in patients with advanced HIV disease and the therapy was well established; it consisted of an induction phase to control the infection with ganciclovir, followed by a lifelong maintenance phase to avoid or delay relapses. METHODS: To determine the safety of CMV maintenance therapy withdrawal in patients with immune recovery after HAART, 35 patients with treated CMV retinitis, on maintenance therapy, with CD4+ cell count greater than 100 cells/mm³ for at least three months, but almost all patients presented these values for more than six months and viral load < 30000 copies/mL, were prospectively evaluated for the recurrence of CMV disease. Maintenance therapy was withdrawal at inclusion, and patients were monitored for at least 48 weeks by clinical and ophthalmologic evaluations, and by determination of CMV viremia markers (antigenemia-pp65), CD4+/CD8+ counts and plasma HIV RNA levels. Lymphoproliferative assays were performed on 26/35 patients. RESULTS: From 35 patients included, only one had confirmed reactivation of CMV retinitis, at day 120 of follow-up. No patient returned positive antigenemia tests. No correlation between lymphoproliferative assays and CD4+ counts was observed. CONCLUSION: CMV retinitis maintenance therapy discontinuation is safe for those patients with quantitative immune recovery after HAART.

Antes da introdução da terapia anti-retroviral altamente efetiva (HAART), a retinite por CMV era uma complicação comum em pacientes com doença por HIV avançada e a terapia era bem estabelecida e consistia em uma fase de indução com ganciclovir para controlar a infecção, seguida por uma manutenção por toda a vida, para evitar e retardar as recidivas. Para determinar a segurança da retirada da terapia de manutenção para retinite por citomegalovírus em pacientes com recuperação imunológica após o HAART, 35 pacientes com retinite por CMV tratados com terapia de manutenção, com contagem de células CD4+ maiores que 100 células/mm³ por no mínimo três meses, mas a maioria dos pacientes apresentava esses valores por mais de seis meses e carga viral < 30.000 cópias/mL, foram avaliados prospectivamente para a recorrência de doença por CMV. A terapia de manutenção foi retirada na inclusão e os pacientes foram monitorados no mínimo 48 semanas por avaliações clínicas e oftalmológicas e pela determinação de marcadores de viremia para CMV (antigenemia). Contagens de CD4+ e CD8+ e níveis de RNA de HIV no plasma. Métodos linfoproliferativos foram realizados em 26/35 pacientes. RESULTADOS: Dos 35 pacientes incluídos no estudo, somente um teve reativação da retinite por CMV confirmada, no dia 120 do seguimento. Nenhum paciente teve testes de antigenemia positivos. Nenhuma correlação entre os ensaios linfoproliferativos e contagens de CD4+ foi observada. CONCLUSÃO: Descontinuação da terapia de manutenção para retinite por CMV é segura para aqueles pacientes com recuperação imune quantitativa após HAART.

Cytomegalovirus Retinitis in a Child with Acute Lymphoblastic Leukemia

PURPOSE: To report a case of cytomegalovirus (CMV) retinitis in a child who had been managed by immunosuppressive chemotherapy for acute lymphoblastic leukemia (ALL). METHODS: An 8-year-old boy who had been managed by immunosuppressive chemotherapy for ALL was referred to the ophthalmologic clinic because of blurred vision in his right eye. Fundus examination showed hard exudates and white retinal leaion in the macular area of the right eye, white retinal lesion accompanied with retinal hemorrhage and exudates in the midperipheral retina of the left eye. Serologic tests demonstrated a positive response of CMV antibody IgG and a negative response of CMV antibody IgM. CMV was isolated upon the culture of bone marrow and peripheral blood. Immunosuppressive chemotherapy was discontinued and ganciclovir was administered. RESULTS: Administration of ganciclovir led to clinical stabilization of the retinitis lesion that was accompanied by scarring. We were able to discontinue the administration of ganciclovir after the retinal lesions were resolved, and no recurrence of CMV retinitis was noted. CONCLUSIONS: Ganciclovir treatment was clinically effective in improving CMV retinitis in an immunocompromised child with ALL. In addition, the improved systemic immune function achieved by discontinuing immunosuppressive chemotherapy permitted discontinuation of anticytomegalovirus therapy.

A Case of Cytomegalovirus Pneumonia and Retinitis in a Patients with Systemic Lupus Erythematosus / 대한류마티스학회지

Cytomegalovirus (CMV) is the member of the herpesviridae of virus, which are large DNA viruses that share the biologic properties of latency and reactivation. In patients with advanced acquired immune deficiency syndrome (AIDS) and those immunocompomised due to bone marrow transplantation or solid organ transplantation, CMV infection is the major cause of morbidity and mortality. CMV pneumonia is the most severe complication of these CMV disease. There have been reported a few cases of CMV interstitial pneumonitis occurring in a patient with SLE after intensive immunosuppressive therapy with prednisolone and cyclophosphamide, and there has been reported a case in Korea. Then we report a case of CMV pneumonia and retinitis occurring in a patient with SLE who was being treated with high dose steroid for 1 month, and was treated with ganciclovir and immunoglobulin.

Therapeutic Effect of Ganciclovir on Cytomegalovirus Retinitis

Cytomegalovirus(CMV) retinitis is the most common opportunistic retinal in fection seen in patients with AIDS. It is almost always progressive and, if untreated, often leads to blindness. The authors report a case of unilateral CMV retinitis in 29-year-old female with AIDS, who complained of decreased vision in the left eye. Fundus examination showed areas of dense white retinal necrosis, scattered hemorrhages and perivascular sheathings. On urine culture CMV was also isolated. Treatment with ganciclovir was started and during the 2 mon ths of treatment, the retinitis was markedly resolved and visual acuity was improved to 0.7. CMV retinitis did not develop in the right eye.

Three Cases of Cytomegalovirus Retinitis in the Immunosuppressed Kidney Transplant Patients

Cytomegalovirus(CMV) infection in normal adults and children is usually asymptomatic. However, CMV represents a potent opportunistic pathogen in immunocompromised hosts, such as neonate, victims of acquired immune deficiency syndrome, organ transplant recipients, and patients receiving immunosuppressive chemotherapy, in whom the virus is capable of causing severe morbidity and mortality. We report three cases of CMV retinitis in the kedney transplat. patients who had been treated with immunosuppressants after transplant.