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Seema Ghelani, Pooja Bhat, Yannek Isaac Leiderman, Jennifer I Lim, Lawrence Joseph Ulanski, William F Mieler, Debra A Goldstein, Ann-Marie Lobo; A comparison of visual outcomes and clinical management of CMV retinitis in HIV and non-HIV positive patients. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3612.
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© ARVO (1962-2015); The Authors (2016-present)
The purpose of this study is to investigate differences in therapy, visual outcomes, and ocular complications between HIV positive and negative patients with active CMV retinitis.
Retrospective record review from 2000-2016 of CMV retinitis patients at UIC. Demographic information, medical history, medications, logMAR visual acuity (VA) (presentation, 1, and 6 months), and ocular complications were recorded.
Fourteen patients (23 eyes) had confirmed CMV retinitis; 8 patients (13 eyes) were HIV positive with mean CD4 count of 37 cells/mm3 at initial presentation (1-110) and 89 cells/mm3 at 6 month follow up (20-220). Of the 6 non-HIV patients (10 eyes), 3 were on immunosuppressive medications (2 solid organ transplants, 1 CLL), 1 had diabetes and neutropenia, 1 aplastic anemia, and 1 congenital CMV.Zone 1 retinitis occurred in 60% of HIV eyes compared to 50% of non-HIV eyes (p=0.44); mean clock hours involved per eye were 9.9 in HIV and 6.0 in non-HIV (p=0.02). The mean number of intravitreal antiviral injections in HIV eyes was 1.75 compared to 8.0 in non-HIV eyes (p=0.007). Intravitreal treatments in HIV group: 5 eyes combined Foscarnet/Ganciclovir, 3 eyes Ganciclovir (GCV) alone, 4 eyes GCV implant. Treatments in non-HIV group included: 7 eyes combined Foscarnet/GCV, 2 eyes GCV alone, 1 eye Foscarnet alone, and 3 eyes GCV implant. 6 non-HIV and 4 HIV patients received combined systemic and local therapies. 1 HIV patient received only systemic therapy.Mean VAs at initial presentation (1.67 vs. 0.8, p=0.07) and one month follow up (1.32 vs. 0.59, p=0.02) were worse in HIV eyes compared to non-HIV eyes. There was no significant difference in VA at 6 month follow up (1.19 vs.1.3, p=0.47) but sample sizes were small. Mean follow up times were 12.8 months (HIV) and 22.1 months (non-HIV) (p=0.18), but 4 HIV patients had <1 month follow up. Retinal detachment occurred in 6/13 (46%) HIV eyes and in no non-HIV eyes.
In this small series of CMV retinitis, HIV patients had a higher rate of retinal detachment, more total clock hours of retinitis, and worse initial VA, suggesting more severe disease; however, there was no difference in VA over time between groups. Long-term visual and anatomic outcomes were limited by significant loss to follow up, especially in HIV patients.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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