Discontinuation of Maintenance Therapy for Cytomegalovirus Retinitis in HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy [Jouan M, et al. AIDS 2001;15:23]: This is a multicenter study involving investigators from France, Spain, and Italy to determine the safety of discontinuing CMV maintenance therapy for HIV-infected patients with CMV retinitis after response to HAART. Maintenance therapy was discontinued if the CD4 cell count >75/mm³ and viral load was <30,000 c/mL. Analysis at 48 weeks showed recurrence of CMV disease in two of 48 patients for a failure rate of 4.2%, including one with recurrence of CMV retinitis and one with "CMV-related peripheral neuropathy." At entry, the median duration of HAART was 18 months, the median CD4 cell count was 239/mm³, and the median HIV viral load was 213 c/mL. At baseline, immune recovery vitreitis was noted with ophthalmological exam in 24 of 59 eyes (41%); this remained stable in eight eyes, deteriorated in four, and improved in six. There were nine eyes that developed immune recovery vitreitis during the 48-week follow-up. Most common was cystoid macular edema.
Comment: This is the largest study to date of CMV retinitis with discontinuation of maintenance therapy following immune reconstitution. The criteria used were a CD4 cell count >75/mm³ and viral load of <30,000 c/mL, but the actual experience was a median CD4 cell count of 239/mm³ and median viral load of 213 c/mL. The current CDC/IDSA guidelines recommend this strategy when the CD4 cell count >100 - 150/mm³, but only when there is concurrence by an ophthalmologist. Particularly interesting in this paper was the finding of "immune recovery vitreitis" in 41% of patients, leading the authors to suggest that all of these patients should undergo "regular and prolonged ophthalmological monitoring after starting HAART." Unfortunately, the authors did not describe the consequences of this complication nor methods of treatment.
posted 3/8/2001

back to news table of contents