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Cytomegalovirus retinitis and acquired immunodeficiency syndrome
D A Jabs1, C Enger, J G Bartlett
1Wilmer Ophthalmological Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205.
Abstract:
In a series of 157 patients with acquired immunodeficiency syndrome (AIDS), 46 (29%) developed cytomegalovirus (CMV) retinitis. In five patients, CMV retinitis was the initial AIDS-defining opportunistic infection (11% of patients with CMV retinitis and 3% of patients with AIDS). Retinal detachments developed in seven patients (15%) and in four were present before the institution of ganciclovir therapy. Bilateral CMV retinitis was present in 35% of patients at presentation and subsequently developed in nine (60%) of 15 patients while not being treated with ganciclovir. Conversely, none of 18 patients with unilateral disease developed bilateral disease while receiving ganciclovir. Of patients treated with ganciclovir for their CMV retinitis, 81% had a response to the drug, and 61% achieved a complete response, resulting in a nonprogressive and inactive scar. Patients who achieved a complete response with ganciclovir had a significantly longer survival than those who did not, suggesting greater immune compromise in those patients who failed to respond to ganciclovir.
Insights
Cytomegalovirus (CMV) retinitis affects 29% of AIDS patients, potentially causing vision loss. Ganciclovir treatment shows an 81% response rate, with complete responses correlating to longer survival.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Immunology
Background:
- Cytomegalovirus (CMV) retinitis is a significant opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS).
- CMV retinitis can be the initial AIDS-defining illness and lead to severe visual impairment, including retinal detachments.
Purpose of the Study:
- To evaluate the incidence and clinical course of CMV retinitis in a cohort of AIDS patients.
- To assess the efficacy of ganciclovir therapy in managing CMV retinitis and its impact on patient survival.
Main Methods:
- Retrospective analysis of 157 AIDS patients, identifying those with CMV retinitis.
- Documentation of initial presentation, development of bilateral disease, retinal detachments, and response to ganciclovir treatment.
Main Results:
- 29% of AIDS patients developed CMV retinitis; 3% presented with it as their initial AIDS-defining infection.
- Retinal detachments occurred in 15% of patients. Ganciclovir therapy demonstrated an 81% response rate, with 61% achieving a complete response.
- Patients achieving a complete response to ganciclovir had significantly longer survival, indicating a correlation between treatment response and immune status.
Conclusions:
- CMV retinitis is a common and sight-threatening complication in AIDS patients.
- Ganciclovir is an effective treatment for CMV retinitis, improving outcomes and survival.
- Treatment response to ganciclovir serves as a prognostic indicator for survival in AIDS patients with CMV retinitis.