Long-lasting remission of cytomegalovirus retinitis without maintenance therapy in human immunodeficiency virus-infected patients

J Infect Dis. 1998 Apr;177(4):1080-3. doi: 10.1086/517399.

Abstract

Seven AIDS patients who were receiving suppressive therapy for previously diagnosed cytomegalovirus (CMV) retinitis were offered treatment with protease inhibitors (PIs). Secondary prophylaxis for CMV was discontinued after 3 months of therapy with PIs if patients had >150 CD4 cells/mm3 and a human immunodeficiency virus (HIV) load of <200 copies/mL and if they were negative for CMV as determined by qualitative CMV polymerase chain reaction (PCR). Ophthalmologic exams were done periodically. After a median follow-up of 9 months (range, 9-12), no new episodes of CMV retinitis were observed. CD4 cell counts were >150 cells/mm3 in all cases, HIV loads were <200 copies/mL, and results for qualitative CMV PCRs remained negative. These observations suggest that for selected patients with healed CMV retinitis who have immunologic and virologic evidence of a clinical response to potent combination antiretroviral therapy, temporary discontinuation of a chronic anti-CMV suppressive therapy may not result in further retinal necrosis. However, the long-term immunologic benefit of PIs and hence the safety of prolonged withdrawal of anti-CMV therapy is unknown.

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy*
  • AIDS-Related Opportunistic Infections / immunology
  • AIDS-Related Opportunistic Infections / virology*
  • Adult
  • Anti-HIV Agents / administration & dosage
  • Anti-HIV Agents / therapeutic use
  • CD4 Lymphocyte Count
  • Cytomegalovirus / genetics
  • Cytomegalovirus / immunology
  • Cytomegalovirus / isolation & purification
  • Cytomegalovirus Retinitis / diagnosis
  • Cytomegalovirus Retinitis / drug therapy*
  • Cytomegalovirus Retinitis / immunology
  • DNA, Viral / genetics
  • DNA, Viral / isolation & purification
  • Drug Monitoring
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Foscarnet / administration & dosage*
  • Foscarnet / therapeutic use
  • Ganciclovir / administration & dosage*
  • Ganciclovir / therapeutic use
  • HIV / immunology
  • HIV / isolation & purification
  • HIV Protease Inhibitors / administration & dosage*
  • HIV Protease Inhibitors / therapeutic use
  • Humans
  • Male
  • Polymerase Chain Reaction
  • RNA, Viral / isolation & purification
  • Recurrence
  • Viral Load

Substances

  • Anti-HIV Agents
  • DNA, Viral
  • HIV Protease Inhibitors
  • RNA, Viral
  • Foscarnet
  • Ganciclovir