Visual field loss in patients with cytomegalovirus retinitis.

Abstract

PURPOSE:

To describe visual field (VF) loss among patients with cytomegalovirus (CMV) retinitis and the risk factors for such loss.

DESIGN:

Multicenter, prospective, observational study.

PARTICIPANTS:

A total of 476 patients with AIDS and CMV retinitis, and VF data.

METHODS:

Follow-up every 3 months with medical history, ophthalmologic examination, Goldmann visual fields, and laboratory testing.

MAIN OUTCOME MEASURES:

Incidence of VF loss in eyes affected with CMV retinitis and characteristics associated with such VF loss.

RESULTS:

Over a median follow-up of 4 years (range, 0.5-9 years), the incidence rates of VF loss to 75% and 50% of normal were 0.22/eye-year (EY, 95% confidence interval [CI], 0.20-0.25) and 0.08/EY (95% CI, 0.06-0.10), respectively. The observed rates were 6- to 7-fold less than those observed rates of VF loss in the era before highly active antiretroviral therapy (HAART). Decreased CD4+ T-cell count, whether measured at enrollment or over follow-up time, was associated with increased rates of VF loss for all VF outcomes in a dose-dependent fashion. Risk factors for VF loss included lower CD4+ T-cell count, CMV lesion size >25% of the total retinal area, and active CMV retinitis after controlling for potential confounding. Highly active antiretroviral therapy use and immune recovery (CD4+ T-cell count >100 cells/μL) were associated with reduced risk of VF loss in multiple regression models. Immune recovery was statistically significantly associated with a lower risk of VF loss to 75% of normal (relative risk [RR] = 0.63; 95% CI, 0.49-0.86; P = 0.003) and to 50% of normal (RR = 0.60; 95% CI, 0.44-0.82; P = 0.001) after controlling for demographic characteristics, HIV viral load, HAART use, CMV lesion location and size, and retinitis activity.

CONCLUSIONS:

Cytomegalovirus retinitis was associated with a substantial risk of incident VF loss, but the incidence is approximately 6-fold lower than that observed in the pre-HAART era. Those who have HAART-induced immune recovery have approximately 40% lower risk of VF loss for both outcomes after controlling for confounding.

• Authors: Jennifer E Thorne, Mark L Van Natta, Douglas A Jabs, Jacque L Duncan, Sunil K Srivastava, Studies of Ocular Complications of AIDS Research Group
• Journal: Ophthalmology (Ophthalmology) Vol. 118 Issue 5 Pg. 895-901 (May 2011) ISSN: 1549-4713 [Electronic] United States
• PMID: 21146225 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anti-HIV Agents

Topics

• AIDS-Related Opportunistic Infections (complications, drug therapy, immunology)
• Adult
• Anti-HIV Agents
• Antiretroviral Therapy, Highly Active
• CD4 Lymphocyte Count
• CD4-Positive T-Lymphocytes (immunology)
• Cytomegalovirus Retinitis (complications, drug therapy, immunology)
• Female
• Follow-Up Studies
• Humans
• Incidence
• Male
• Middle Aged
• Prospective Studies
• Risk Factors
• Vision Disorders (diagnosis, etiology, physiopathology)
• Visual Acuity (physiology)
• Visual Field Tests
• Visual Fields