Comparison of Treatment Regimens for Cytomegalovirus Retinitis in Patients with AIDS in the Era of Highly Active Antiretroviral Therapy

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• 作者：Douglas A. Jabs ; MD ; MBA¹ ; ² ; ³ ; ^{douglas.jabs@mssm.edu} ; Alka Ahuja ; MS³ ; Mark Van Natta ; MS³ ; J.P. Dunn ; MD⁴ ; Steven Yeh ; MD⁵ ; Studies of the Ocular Complications of AIDS Research Group ?li>
• 刊名：Ophthalmology
• 出版年：2013
• 出版时间：June, 2013
• 年：2013
• 卷：120
• 期：6
• 页码：1262-1270
• 全文大小：312 K

文摘

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lass=""h4"">Purpose

To describe the outcomes of different treatment approaches for cytomegalovirus (CMV) retinitis in the era of highly active antiretroviral therapy (HAART).

lass=""h4"">Design

Prospective cohort study, the Longitudinal Study of the Ocular Complications of AIDS.

lass=""h4"">Participants

A total of 250 patients with CMV retinitis and a CD4+ T-cell count <100 cells/¦Ìl (n = 221) at enrollment or incident retinitis (n = 29) during cohort follow-up.

lass=""h4"">Methods

The effects of systemic therapy (vs. intraocular therapy only) on systemic outcomes and the effect of intraocular therapies (ganciclovir implants, intravitreal injections) on ocular outcomes were evaluated.

lass=""h4"">Main Outcome Measures

Mortality, CMV dissemination, retinitis progression, and treatment side effects.

lass=""h4"">Results

Regimens containing systemic anti-CMV therapy were associated with a 50 % reduction in mortality (adjusted hazard ratio [HR], 0.5; 95 % confidence interval [CI], 0.3-0.7; P = 0.006), a 90 % reduction in new visceral CMV disease (adjusted HR, 0.1; 95 % CI, 0.04-0.4; P = 0.004), and among those with unilateral CMV retinitis at presentation, an 80 % reduction in second eye disease (adjusted HR, 0.2; 95 % CI, 0.1-0.5; P = 0.0005) when compared with those using only intraocular therapy (implants or injections). Compared with systemic treatment only, regimens containing intravitreal injections had greater rates of retinitis progression (adjusted HR, 3.4; P = 0.004) and greater visual field loss (for loss of one half of the normal field, adjusted HR, 5.5; P < 0.01). Intravitreal implants were not significantly better than systemic therapy (adjusted HR for progression, 0.5; P = 0.26; adjusted HR for loss of one half of the visual field, 0.5; P = 0.45), but the sample size was small. Hematologic and renal side effect rates were similar between those groups with and without systemic anti-CMV therapy. The rate of endophthalmitis was 0.017 per eye-year (EY) (95 % CI, 0.006-0.05) among those treated with intravitreal injections and 0.01 per EY (95 % CI, 0.002-0.04) among those treated with an implant.

lass=""h4"">Conclusions

In the HAART era, systemic anti-CMV therapy, while there is immune compromise, seems to provide benefits in terms of longer survival and decreased CMV dissemination.

lass=""h4"">Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.