Br J Ophthalmol 1998;82:988-990 ( September )
Effects of protease inhibitors on the course of CMV retinitis in
relation to CD4+ lymphocyte responses in HIV+ patients
Gerardus J van den Horn,a
Christina Meenken,a
Sven A Danner,b
Peter Reiss,b
Marc D de Smeta
a Department of
Ophthalmology, Division of Infectious Diseases, Tropical Medicine and
AIDS, Academic Medical Centre, University of Amsterdam, Netherlands, b Department of Internal Medicine, Division of Infectious
Diseases, Tropical Medicine and AIDS, Academic Medical Centre,
University of Amsterdam, Netherlands
Correspondence to: G J van den Horn, MD,
University of Amsterdam, Academic Medical Centre, Department of
Ophthalmology Rm G2-254, PO Box 22700, 1100 DE Amsterdam, Netherlands.
Accepted for publication 4 March 1998
AIM
To gain insight into the course of CMV
retinitis (CMVR) in AIDS patients receiving protease inhibitors (PI),
and to evaluate whether certain patterns of CD4 response are indicative
of the clinical outcome and the risk of recurrence.
METHODS15 consecutive AIDS patients receiving
maintenance therapy for CMVR were included in a prospective
observational cohort study at the university hospital between July and
October 1996. Patients were evaluated for signs of CMVR activity and
intraocular inflammation. CMVR recurrence was defined as the primary
clinical endpoint. Follow up was performed until July 1997. No
patient was lost to follow up. Clinical outcome was related to CD4+
lymphocyte counts, which were monitored every 6 weeks. Highly active
antiretroviral treatment regimen including PI was started at study entry.
RESULTSAll recurrences (n=7) were in patients who
failed to have a sustained increase in CD4 counts, whereas CMVR
remained inactive during a follow up of 42-52 weeks in those who were
able permanently to restore their CD4 values to 100×106/l
or more (n=5). The remaining three patients died after 12, 16, and 50 weeks, respectively, without recurrences. All relapses of CMVR were
seen after 6-16 weeks, and at CD4 counts well below 100×106/l.
CONCLUSIONSThe beneficial effects of PI treatment
correlate with the pattern of CD4 response. Sustained increases in CD4
counts achieved in the first 16 weeks of treatment are associated with
a prolonged period of CMVR quiescence. Poor initial response is
associated with a high risk of CMVR recurrence.
Keywords:
AIDS;
cytomegalovirus retinitis;
HAART;
protease
inhibitors
© 1998 by British Journal of Ophthalmology
