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Elizabeth A. Sugar, Douglas A. Jabs, Alka Ahuja, Jennifer E. Thorne, Ronald P. Danis, Curtis L. Meinert, Studies of the Ocular Complications of AIDS Research Group; Cytomegalovirus Retinitis Incidence in the Highly Active Antiretroviral Therapy (HAART) Era. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4267.
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Cytomegalovirus retinitis (CMVR) is among the most common ocular opportunistic infections for patients with AIDS. Prior to the availability of effective anti-retroviral therapy, approximately 30% of patients with AIDS developed CMVR during their lifetime, 25% within 4 years of diagnosis with AIDS. Our goal is to document the incidence and risk factors for CMVR in the era of highly active antiretroviral therapy (HAART) based upon patients with AIDS in the Longitudinal Study of Ocular Complications of AIDS (LSOCA) cohort.
Disease history, laboratory testing (CD4+ and CD8+ T cell counts, HIV viral load), and ophthalmologic exams were obtained every six months. Cox proportional hazards models were used to compare risk factors for incidence.
In the HAART era, the incidence rate for CMVR was 0.35/100 person years (PY) and for individuals or individuals with a CD4+ T cell count below 50 cells/µL at the prior visit, the rate was 3.84/100 PY, a significant increase (p < 0.01). Additional factors associated with increased risk included CD8+ T cell counts below 400 cells/µL (HR: 14, p < 0.01), HIV viral load > 10,000 copies/mL (HR: 38, p < 0.01), presence of HIV retinopathy (HR: 10, p < 0.01), and Karnofsky score < 80 (HR: 2, p = 0.04).
In the HAART era, patients with AIDS remain at risk for developing CMVR. This risk is significantly higher for those with low CD4+ T cell counts. However, the rate is much lower than the rate observed in the pre-HAART era.
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