Discontinuing anticytomegalovirus therapy in patients with immune reconstitution after combination antiretroviral therapy

PURPOSE: To describe our experience with dis continuation of anticytomegalo virus maintenance therapy in patients who have had immune reconstitution af ter initiation of highly active antiretroviral therapy. METHODS: Fifteen patients with treated cytomegalovirus retinitis, who had i mmune reconstitution after initiation of highly active retroviral therapy, had anticytomegalovirus maintenance therapy discontinued. Patients were fol lowed closely for relapse of retinitis. RESULTS: Median nadir CD4(+) T-cell count, before institution of highly act ive antiretroviral therapy, was 20 cells/mu l. At the time of discontinuati on of anticytomegalovirus therapy, median CD4(+) T-cell count was 297 cells /mu l. Patients were followed for a median of 8 months off anticytomegalovi rus therapy (range, 3 to 16 months). The median CD4(+) T-cell count at last follow-up was 267 cells/mu l. No patient off anticytomegalovirus therapy r elapsed. CONCLUSION: In selected patients with immune reconstitution after initiatio n of highly active antiretroviral therapy, anticytomegalovirus therapy may be safely discontinued, at least temporarily. Longer follow-up of these pat ients is needed to determine how long such therapy may be interrupted, and when anticytomegalovirus therapy should be reinstituted. (Am J Ophthalmol 1 998; 126:817-822, (C) 1998 by Elsevier Science Inc. All rights reserved.).