WHEN SHOULD HIV-PATIENTS HAVE AN EYE EXAM INATION - SCREENING PARAMETERS FOR CMV-RETINITIS

Background To reduce the burden of frequent visits at the physician we have checked (I) for which ocular manifestations in HIV-infection scr eening of asymptomatic patients is worthwhile and (II) which parameter s may indicate patients at risk for CMV-retinitis. Patients and Method s The clinical data of 215 HIV-infected patients were analyzed retrosp ectively. Only those ocular manifestations were considered suitable fo r screening that (a) endanger vision, (b) are treatable, (c) can be di agnosed sufficiently early and (d) are common. Furthermore (1) CDC-sta ge, (2) CD4+ count, (3) HIV-retinopathy, (4) CMV-uria and (5) CMV-anti bodies were checked for their usefulness in indicating patients at ris k for CMV-retinitis. Results Ophthalmological screening of asymptomati c HIV-patients should focus on cytomegalovirus (CMV)-retinitis because early diagnosis of this common blinding disease improves the visual o utcome. 85 of 215 HIV-infected patients had a CD4+ count less than 50 cells/mu l. 25% of these patients developed CMV-retinitis (21/85). The risk for CMV retinitis rose to 38% (13/34) when the low CD4+ count wa s accompanied by CMV-uria. The proportion of patients with CMV-retinit is did not increase when HIV-retinopathy had been diagnosed earlier (1 2/48 = 25%). CMV-serology and CDC-classification were not helpful in s creening for CMV-retinitis. Conclusions We recommend the following oph thalmological screening scheme for HIV-patients without ocular symptom s: (1) patients with a CD4+ count < 100 cells/mu l should be checked e very third month and (2) those with a CD4+ count <50 cells/mu l and CM V-uria every sixth week.