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Dean R Cugley, Szczepan Nowakowski, Julian Druce, Lyndell L Lim; Rise in incidence of CMV retinitis in the HIV-negative population at a tertiary referral centre in Australia.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4182.
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© ARVO (1962-2015); The Authors (2016-present)
To report the rise in incidence of CMV retinitis in HIV-negative patients at the Royal Victorian Eye and Ear Hospital (RVEEH); the major tertiary ocular referral centre for the state of Victoria, Australia; and to determine potential risk factors that may influence susceptibility to CMV retinitis.
The Victorian Infectious Disease Reference Laboratory database was searched for CMV positive results on all ocular specimens (anterior chamber paracentesis and/or vitreous biopsy) obtained between 2007 to 2017 from the RVEEH. The case histories of the patients with positive CMV PCR results were reviewed to identify any potential risk factors, such as underlying systemic disease, or the use of systemic medications. We then compared the incidence of these presentations with population growth in the referral area, as well as the addition of new immunosuppressive agents for the treatment of systemic autoimmune conditions to the Pharmaceutical Benefits Scheme (PBS), the publicly-funded Australian medication scheme.
A total of 11 patients were identified who had clinical evidence of CMV retinitis during the study period. Between 2007 and 2013, there were no patients presenting with CMV retinitis, with all 11 cases occurring in the last 4 years, and 4 cases in 2017. Of these, only one was HIV positive. This rise in incidence was far in excess of population growth of 18% during the corresponding time period. Of the non-HIV patients, one had a solid lung tumour, four had haematological malignancies, one was immunosuppressed post renal transplantation, and one was immunocompetent.In 2017, two cases (50%) were receiving treatment with the newly introduced biologic response modifier tofacitinib, which became available in Australian on the PBS in October 2015. There has been documented susceptibility to herpes zoster infection in patients on tofacitinib; these two cases in 2017 may be indicative of a similar phenomenon with CMV.
The incidence of CMV retinitis at RVEEH has risen beyond population growth, and may reflect the increasing use of biologic response modifiers for the treatment of systemic autoimmune conditions and malignancies. Ophthalmologists should therefore be alert to the possibility of CMV retinitis in patients on biologic agents such as tofacitinib, in order to ensure the best visual outcome with early treatment intervention.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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