This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (43)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Social Bookmarking   What's this?

Scott M. Whitcup, MD

JAMA. 2000;283:653-657.

A number of striking changes have occurred recently in the presentation and course of cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome (AIDS) who are receiving highly active antiretroviral therapy (HAART). Before the use of HAART, CMV retinitis was the most common intraocular infection in patients with AIDS, occurring in up to 40% of patients, typically when CD4⁺ cell counts have decreased to less than 0.10 x 10⁹/L. By studying CMV retinitis, clinicians can investigate whether the rejuvenated immune system that results from HAART can effectively control opportunistic infections in patients with AIDS. In some patients, retinitis has not progressed when specific anti-CMV therapy was discontinued, but a number of patients have developed substantial intraocular inflammation, which has resulted in decreased visual acuity. Anterior uveitis, cataract, vitritis, cystoid macular edema, epiretinal membrane, and disc edema may occur in patients with CMV retinitis who have experienced HAART-associated elevation in CD4⁺ cell counts. Since immune recovery uveitis does not occur in eyes without CMV retinitis, the ocular inflammation appears to be related to the CMV infection. Anti-CMV maintenance therapy likely can be safely discontinued in some patients with CMV retinitis if CD4⁺ cell counts are stable or increasing and have been higher than 0.10 x 10⁹/L for at least 3 months. Immune recovery in patients receiving HAART has been effective in controlling opportunistic infections, but it may also result in intraocular inflammation, which can have adverse effects on the eye.

Author Affiliation: Clinical Branch, National Eye Institute, National Institutes of Health, Bethesda, Md. Dr Whitcup is now with Allergan, Inc, Irvine, Calif.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

February 2, 2000
JAMA. 2000;283(5):681-682.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

What you can see in your patient's eyes? Review of ocular manifestations of HIV in HAART era
Nasoodi et al.
Int J STD AIDS 2008;19:4-11.
ABSTRACT | FULL TEXT  

Eosinophilic Folliculitis: Before and After the Introduction of Antiretroviral Therapy
Rajendran et al.
Arch Dermatol 2005;141:1227-1231.
ABSTRACT | FULL TEXT  

Immune Reconstitution Inflammatory Syndrome Associated With Kaposi's Sarcoma
Bower et al.
JCO 2005;23:5224-5228.
ABSTRACT | FULL TEXT  

Sarcoidosis Following HIV Infection: Evidence for CD4+ Lymphocyte Dependence
Morris et al.
Chest 2003;124:929-935.
ABSTRACT | FULL TEXT  

Viral genome quantification as a tool for improving patient management: the example of HIV, HBV, HCV and CMV
Berger and Preiser
J Antimicrob Chemother 2002;49:713-721.
ABSTRACT | FULL TEXT  

Pulmonary Manifestations of HIV Infection in the Era of Highly Active Antiretroviral Therapy
Wolff and O'Donnell
Chest 2001;120:1888-1893.
ABSTRACT | FULL TEXT  

Discontinuation of Mycobacterium avium Complex Prophylaxis in Patients with Antiretroviral Therapy-Induced Increases in CD4+ Cell Count: A Randomized, Double-Blind, Placebo-Controlled Trial
Currier et al.
ANN INTERN MED 2000;133:493-503.
ABSTRACT | FULL TEXT  

Immune Restoration With Antiretroviral Therapies: Implications for Clinical Management
Lederman and Valdez
JAMA 2000;284:223-228.
ABSTRACT | FULL TEXT  

New Issues in the Management of Patients With AIDS-Related Cytomegalovirus Retinitis
Arch Ophthalmol 2000;118:704-706.
FULL TEXT