Prevalence and Characteristics of CMV Retinits in HIV Patients in Ho Chi Minh City, Vietnam

Abstract

Purpose: : Since 2004, the Harvard Medical School AIDS Initiative (HAIVN) has provided training and technical assistance on HIV care and anti-retroviral therapy (ART) in Vietnam as part of the US government PEPFAR program. Cytomegalovirus retinitis (CMVR) has never been treated before in the country. We aim to describe the results of a pilot study to determine the prevalence and characteristics of CMVR among HIV patients in Ho Chi Minh City (HCMC), Vietnam. Results of this study will be used to develop new treatment programs for CMVR in Vietnam.

Methods: : A cross-sectional prospective study of high-risk AIDS patients (CD4 < 100) recruited from public HIV clinics in HCMC. Patients were referred to trained Ophthalmologists for screening. Descriptive ophthalmological data and laboratory results were collated, including visual acuity (VA), ocular complications, treatments and CD4 counts.

Results: : Between January and April 2010, two ophthalmologists trained in indirect ophthalmoscopy and diagnosis of CMVR screened a total of 201 patients. The mean age was 33.0 yrs, 77% were male and median CD4 was 47/mm³. 62% were on antiretroviral therapy (ART) for a median of 12 weeks. 14 patients (16 eyes) had CMVR, giving a prevalence of 7.0% (95% CI 3-11%). There was no significant difference in the prevalence between patients with CD4 <50/mm³ (7.6%) and CD4 50-100/mm³ (6.2%)(p=0.703). At diagnosis, 8.1% of patients on ART and 5.2% of ART-naïve patients were found to have CMVR (p=0.437). Presence of CMVR was not associated with age, gender, injection drug use, WHO clinical stage or ART status.CMVR was diagnosed in 29.4% (5/17) of symptomatic patients but in only 4.9% (9/184) of asymptomatic patients (p<0.001). 28.6% of patients with CMVR reported some blurring of vision and those with VA<20/40 were more likely to have CMVR (p<0.001). On multivariate analysis, independent predictors for CMVR were blurring of vision (OR 12.0; p=0.001) and abnormal VA (OR 5.4, p=0.004).

Conclusions: : In HCMC, CMVR is seen in 7% of HIV-infected patients with CD4 <100/mm³. Use of ART and CD4 count were not predictable for the presence of CMVR. HIV-infected patients with a CD4 count <100/mm³ or develop visual blurring with VA <20/40 in Vietnam should be referred for early ophthalmological screening.

Keywords: cytomegalovirus • AIDS/HIV • clinical (human) or epidemiologic studies: prevalence/incidence