EVOLUTION OF CYTOMEGALOVIRUS RETINITIS IN AIDS PATIENTS TREATED BY TRIPLE ANTIRETROVIRAL COMBINATION THERAPY

Purpose The recent developments of protease inhibitors mise big hopes for the fight against AIDS. Combined in a triple therapy with 2 nucleo side analogs, those molecules strongly inhibit human immunodeficiency virus (HIV) replication, Their biological and clinical efficacy for in creasing CD4 cell count and survival nl time has been proved. We have followed evolution of Cytomegalovirus (CMV) retinitis in 12 patients t reated by triple antiretroviral combination therapy since April 1996, Patients and methods Twelve AIDS patients with CMV retinitis backgroun d and a treatment by triple therapy were followed in this prospective study. At the onset of combination therapy retinitis was cicatricial t l IO patients and active iii 2 patients. Mean CD4 cell count was 23 +/ - 16 CD4/mu L [4-50], Follow-up included ophthalmoscopic examination e very 2 weeks and fundus photographs every month. CD4 cell count was no ted at each exam. Results The mean time follow-lip after onset of comb ination therapy was 10.3 +/- 2.4 months [5 -14], Retinitis relapsed in 6 patients (50 %) within the 3 first months, and with a CD4 cells cou nt higher than 75/mu L Sor 3 patients. Inflammation response ns noted ir 3 patients. There was no recurrence after the third month, except i n I case at the 9th month. CD4 cell count was 122 +/- 41 CD4/mu L [30 -350] after 6 months. As retinal lesions were completely still for sam e patients. maintenance therapy was reduced then even stopped. At the end of follow-up, maintenance therapy was stopped for 8 patients. For these patients. retinitis remained stable without maintenance therapy for a mean time of 4,5 months (10 months in I case). Recurrence occurr ed Sor only I patient after jr months of triple therapy and 2 months w ithout maintenance therapy, For the II remaining patients, retinitis r emained stable for a mean total time of 9.5 +/- 2.5 months [4.5 -12.5] . Conclusion Those first results show that clinical and therapeutic hi story of CMV retinitis may be changing. There seems to be a restoratio n of immune defenses that allowed suppression of maintenance therapy f or 8 ou; of 12 patients. Our results need to be confirmed by a longer follow-up and multicentric studies.