Purpose:
To describe the epidemiological trend of cytomegalovirus retinitis (CMVR) among HIV patients in Singapore.
Methods:
A retrospective cohort study was conducted on all HIV patients diagnosed with CMVR from 2005 to 2010 at the CDC in Singapore. Information collected included patient demographics, clinical symptoms and signs, associated medical history and laboratory results. Their prevalence and clinical trends over time were analyzed.
Results:
Of 224 new patients with CMVR, 92.9% were male, 96.0% were on HAART. Mean age was 43.3 years, with bilateral disease seen in 33.5%. Median CD4 count at HIV diagnosis was 38.0 cells/μL (range 1-714) and on a general decline. Median CD4 count at CMVR diagnosis was 33.0 cells/μL (range 1-465). Median duration of HAART initiation from HIV diagnosis was 6.0 months but progressively shorter over time. Median time lag from HIV to CMVR diagnosis was 20.5 months.The most common symptom at CMVR diagnosis was blurring of vision (47.3%) and 32.4% were asymptomatic. About 50% were <25% in lesion size and occurred in zone 2. Pneumocystis jirovecii pneumonia (PCP) was the most common concomitant opportunistic infection (OI). OIs were noted to be on a rising trend over the years.Incidence rates of HIV patients with CMVR had ranged from 8.0 to 12.9 cases per 1000 person-years over our study period, with an overall incidence rate of 10.2 cases per 1000 person-years. Mortality rate was 19.4 deaths per 1000 person-years. Mean survival time was 162.2 months (95%CI: 152-172). 25 patients died during our study period. In comparison, they were older at HIV and CMVR diagnoses, had lower CD4 count at CMVR diagnosis and a shorter time lag from HIV to CMVR diagnoses.Worse prognoses were associated with older age at CMVR diagnosis (HR: 1.05; 95%CI: 1.02-1.09), and also with shorter time lag from HIV to CMVR diagnosis (HR: 0.98; 95%CI: 0.97-0.997). Patients with concomitant atypical Mycobacterial infection were more likely to experience earlier death by a factor of 3.11 (95%CI: 1.26-7.67). Those on HAART were less likely to experience earlier death by a factor of 0.27 (95%CI: 0.08-0.89).
Conclusions:
From 2005 to 2010, the incidence rate of HIV patients with CMVR in Singapore was 10.2 cases per 1000 person-years with a decreasing trend seen over the years. Median duration of HAART initiation from HIV diagnosis had decreased, reflecting earlier initiation of therapy in accordance to current guidelines. Patients had increasingly more OIs over the study period, consistent with later presentations and a general decline in CD4 count at HIV diagnosis. Poor prognostic factors included older age at CMVR diagnosis, atypical Mycobacterial infection and shorter time lag from HIV to CMVR diagnosis.
Keywords: cytomegalovirus • AIDS/HIV • clinical (human) or epidemiologic studies: prevalence/incidence