Changing trends in cytomegalovirus retinitis with triple therapy

Purpose Cytomegalovirus retinitis (CMVR) has been the most common cause of visual loss in AIDS patients. We investigate whether the pattern of disease has changed since the introduction of triple therapy. Methods We reviewed the records of all patients with CMVR in one teaching h ospital HIV unit over a 2 year period (n = 24). This included the ophthalmi c and systemic findings, HIV and CMV treatment, survival after diagnosis an d CD4 results. Results There has been a marked decrease in the number of patients developi ng new CMVR: from 21 eyes (15 patients) to 4 eyes (4 patients) in two conse cutive 12 month periods between January 1996 and December 1997, coinciding with the introduction of triple therapy in October 1996. Median survival ha s increased from 376 days in the deceased patients to 598 days in the survi vors on triple therapy. Median time to CMVR relapse has lengthened from 79 to 179 days in the triple therapy cohort. The pattern of ocular morbidity i n the 11 eyes of the 7 surviving patients is also changing, with no new zon e 1 disease, and a marked rise in the incidence of uveitis, maculopathy and cataracts. Conclusion Results suggest that triple therapy is associated with an increa se in survival, a decrease in CMVR relapse and changes in ocular features. This transition has implications for current screening and treatment protoc ols.