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Joseph B Alsberge, Somsanguan Ausayakhun, Choeng Jirawison, Yingna Liu, Michael Yen, Todd P Margolis, Jeremy D Keenan; Incidence of cytomegalovirus (CMV) retinitis in fellow eyes of HIV-infected patients with unilateral CMV retinitis treated with intravitreal ganciclovir injections. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4501.
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© ARVO (1962-2015); The Authors (2016-present)
To calculate the incidence and risk factors for the development of CMV retinitis in the fellow eyes of a cohort of HIV-infected patients with unilateral CMV retinitis undergoing treatment with repeated intravitreal ganciclovir injections.
In this prospective cohort study, 25 consecutive HIV-infected patients with unilateral CMV retinitis received repeated dilated fundus examinations according to a standardized schedule for 12 months. The incidence of new-onset CMV retinitis in the non-affected eye was calculated, and baseline risk factors for fellow eye involvement calculated using a Cox proportional hazards model.
The median duration of follow up was 51 weeks (IQR 31 to 52). The incidence of fellow eye development of CMV retinitis during the first year at risk was 0.03 per person-month (95%CI 0.01 to 0.07). However, the risk was not constant over the follow-up period, with a much higher risk in the first 3 months (incidence 0.08 per person-month, 95%CI 0.03 to 0.19) compared with the remainder of the year (incidence 0.008, 95%CI 0.001 to 0.06); P=0.001. Cox proportional hazards models did not reveal any statistically significant relationships between development of CMV retinitis in the fellow eye and baseline age (P=0.45), sex (P=0.67), CD4 count (P=0.28), or posterior pole (zone 1) disease in the first eye (P=0.12). However, fellow eye involvement was associated with antiretroviral status at baseline, with lack of antiretroviral therapy associated with a 7.7-fold increased risk of fellow eye involvement (95%CI 1.5 to 38.8; P=0.01).
A Thai population of HIV-infected patients with unilateral CMV retinitis treated with intravitreal ganciclovir injections had an 8% risk of developing CMV retinitis in the fellow eye over the first 3 months, and a much lower risk thereafter. Systemic antiviral therapy for at least the first few months after diagnosis may be helpful in reducing development of retinitis in the fellow eye.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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