ABSTRACT
Cytomegalovirus (CMV) retinitis may be treated systemically or intravitreally. We reviewed retrospectively patients with CMV retinitis, in order to determine whether systemic treatment was associated with less spread of CMV retinitis from one eye to the other. Of 222 cases, 92 patients had bilateral disease at onset of CMV retinitis, leaving 130 for analysis. Bilaterality occurred in 10 patients during 12,687 days of systemic treatment and in 34 during 14,791 days without systemic treatment (odds ratio [OR] = 2.92; confidence interval [CI], 1.44-5.90). Patients who had received systemic treatment for <50% of the follow-up period had a greater risk of bilaterality (OR = 3.7; CI, 2.79-4.54) than did the more intensively treated patients. CD4 cell levels also contributed to increased risk, but multivariate analysis showed that CD4 cell counts and treatment intensity were independent risk factors. CMV retinitis was more likely to become bilateral in patients who received less intravenous therapy. Local treatment can complete but does not replace systemically administered therapy.
Subject(s)
Antiviral Agents/administration & dosage , Cytomegalovirus Retinitis/drug therapy , Cytomegalovirus Retinitis/prevention & control , Foscarnet/administration & dosage , Ganciclovir/administration & dosage , Adult , CD4 Lymphocyte Count , Cytomegalovirus Retinitis/immunology , Cytomegalovirus Retinitis/transmission , Drug Therapy, Combination , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
Foscarnet inhibits human immunodeficiency virus (HIV) replication in vitro and decreases p24 antigenemia in patients with cytomegalovirus (CMV) retinitis. To evaluate the effect of foscarnet on HIV replication, HIV RNA was quantitated in 17 patients before and during foscarnet therapy. Fifteen patients had CMV retinitis, 1 had CMV encephalitis, and 1 had intractable zoster. A decrease in HIV RNA was observed in 16 of 17 patients. Before the introduction of foscarnet, mean HIV RNA was 5.82 +/- 0.24 log RNA/mL and, after a median of 13 days of therapy, mean HIV RNA was 5.30 +/- 0.27 log RNA/mL (P < .001). Among patients with detectable p24 antigen at baseline, a significant decrease was observed (P = .017). This decrease in HIV RNA demonstrates that foscarnet is a potent antiretroviral drug.
Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/virology , Cytomegalovirus Infections/drug therapy , Foscarnet/therapeutic use , HIV/genetics , RNA, Viral/biosynthesis , AIDS-Related Opportunistic Infections/immunology , AIDS-Related Opportunistic Infections/mortality , Acquired Immunodeficiency Syndrome/immunology , CD4 Lymphocyte Count , Cytomegalovirus Infections/etiology , Cytomegalovirus Infections/mortality , Flow Cytometry , HIV/drug effects , HIV Core Protein p24/analysis , HIV Core Protein p24/biosynthesis , Humans , Prospective Studies , RNA, Viral/antagonists & inhibitors , Retrospective Studies , Survival Rate , Time FactorsABSTRACT
Cytomegalovirus retinitis (CMV) is the most common ocular opportunistic infection seen in patients with acquired immune deficiency syndrome. The anterior segment is usually quiet or with minimal aqueous humour flare and cell reaction. Nevertheless, in this prospective study of 30 eyes with CMV retinitis, 22 (73%) had white, small and filamentous keratic precipitates (KPS) which seem to corroborate this inflammation. The positivity of the KPS depends upon the extent of CMV retinitis.
