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Shigeko Yashiro, Takeshi Nishijima, Yoshimi Kikuchi, Yuuka Yamamoto, Harumi Fukushima, Sho Ichinohe, Shinichi Oka; Clinical characteristics of cytomegalovirus retinitis in human immunodeficiency virus infected patients for recent five years.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4184. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
The number of cytomegalovirus (CMV) retinitis in human immunodeficiency virus (HIV) infected patients has been decreasing after the evolution of antiretroviral therapy (ART). We performed a retrospective, observational study to investigate the recent clinical characteristics of CMV retinitis in HIV infected patients.
We analyzed the cases treated at AIDS Clinical Center, National Center for Global health and Medicine, one of the largest referral centers for HIV infection in Japan for five years (2011-2015). HIV-infected patients with CMV retinitis that fulfilled the standard AIDS Clinical Trials Group (ACTG) criteria for “confirmed CMV retinitis” were included in the study which required diagnosis by an experienced ophthalmologist and documentation of CMV retinitis by retinal photography. Full ophthalmologic examinations were performed for each study patient. Basic characteristics, including sex, age, observation period, CD4-positive T lymphocyte count (CD4), CMV-DNA PCR, duration of ART at the onset and other general complications as well as ophthalmologic parameters, such as the zone where the lesions occurred, and visual acuity were collected from the medical chart.
Twenty-seven eyes of 23 male patients developed CMV retinitis (mean age 42.3 years, range 21 to 56). The mean observation period for CMV retinitis was 20.7± 17.5 months (range 1 to 55). CD4 and CMV-DNA PCR ranged from 5 to 275 per μL and from undetectable to 200,000 copies/mL, respectively. For 4 patients, CMV retinitis developed in a form of immune reconstitution syndrome. The most frequent complication was malignant lymphoma (ML) for 8 patients, followed by pneumocystis pneumonia for 7 patients. Six out of 8 patients with ML and one patient with cholangiocarcinoma died during the study period. Five out of 9 eyes (56%) of patients with ML included zone 1 disease, on the contrary to 6 out of 18 (33%) eyes of patients without ML. Best corrected visual acuity decreased 2 or more lines for 4 eyes, all of which included zone 1 disease.
More than one third of CMV retinitis developed in patients on the treatment for ML. Such patients had high mortality rate and tended to have a zone 1 disease which affects the visual prognosis.
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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