Incidence and risk factors for developing cytomegalovirus retinitis in HIV-infected patients receiving protease inhibitor therapy. Spanish CMV-AIDS Study Group.

Abstract

OBJECTIVE:

To assess the incidence and risk factors for cytomegalovirus (CMV) retinitis in HIV-infected patients who initiated protease inhibitor-containing antiretroviral therapy.

DESIGN AND SETTING:

Prospective, multicentre study.

PATIENTS:

A cohort of 172 HIV-infected patients with a CD4 cell count below 100x10(6) cells/l at the time of protease inhibitor introduction.

MAIN OUTCOME MEASURES:

Confirmed CMV retinitis and mortality, according to CD4 cell count, HIV load, and CMV viraemia.

RESULTS:

The cumulative incidence of CMV retinitis was 5% at 1 year and 6% at 2 years. Only a positive CMV polymerase chain reaction (PCR) test at therapy initiation was significantly associated with the development of disease (relative hazard, 4.41; 95% confidence interval, 2.12-8.93; P<0.00001). The 12-month Kaplan-Meier CMV retinitis event rate was 38% in patients who were CMV PCR-positive compared with 2% in those who were CMV PCR-negative (P<0.001). Mean CMV load was significantly higher in those individuals who went on to develop CMV retinitis (3700 versus 384 copies/ml, P = 0.002). Only 2% of patients remained CMV PCR-positive after 3 months of protease inhibitor therapy, and CMV viraemia was not associated with a worse therapy response or shorter survival. Transient CMV positivity without a higher risk of disease was observed in 7% of patients at the first month on therapy.

CONCLUSIONS:

Protease inhibitor-containing antiretroviral therapy significantly reduces the incidence of CMV viraemia and disease. Although a positive CMV PCR test identifies those patients on therapy at highest risk of CMV retinitis, it is not associated with an increased risk of death or a worse response to protease inhibitor therapy.

• Authors: J L Casado, J Arrizabalaga, M Montes, P Martí-Belda, C Tural, J Pinilla, C Gutierrez, J Portu, R Schuurman, K Aguirrebengoa
• Journal: AIDS (London, England) (AIDS) Vol. 13 Issue 12 Pg. 1497-502 (Aug 20 1999) ISSN: 0269-9370 [Print] England
• PMID: 10465073 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• DNA, Viral
• HIV Protease Inhibitors

Topics

• AIDS-Related Opportunistic Infections (diagnosis, epidemiology, virology)
• CD4 Lymphocyte Count
• Cytomegalovirus (isolation & purification, physiology)
• Cytomegalovirus Retinitis (diagnosis, epidemiology, virology)
• DNA, Viral (analysis)
• HIV Infections (drug therapy)
• HIV Protease Inhibitors (therapeutic use)
• HIV-1 (physiology)
• Humans
• Incidence
• Polymerase Chain Reaction
• Prospective Studies
• Risk Factors
• Viral Load
• Viremia (virology)