INCREASING SURVIVAL IN AIDS PATIENTS WITH CYTOMEGALOVIRUS RETINITIS TREATED WITH COMBINATION ANTIRETROVIRAL THERAPY INCLUDING HIV PROTEASE INHIBITORS

Objective: To assess the effect of combination antiretroviral therapy including HIV protease inhibitors on the survival of patients with cyt omegalovirus retinitis (CMVR). Design and participants: A longitudinal study of patients with CMVR diagnosed between October 1992 and May 19 96 and followed to May 1997. Setting: UK National Health Service speci alist HIV medicine department. Outcome measure: Time to death from fir st diagnosis of CMVR. Data were censored on 31 May 1997. Results: Data were available on 147 patients with CMVR. Median survival of CMVR pat ients before December 1995 was 256 days [95% confidence interval (Cl), 197-315]. Following the introduction of protease inhibitors in Decemb er 1995 this rose to 555 days (95% Cl, 351-759). By 31 May 1996 median survival for the entire group of patients alive with CMVR had risen t o 720 days (95% Cl, 551-889). The mean survival after CMVR diagnosis w as 224 days (n = 89; 95% Cl, 186-261; 1-year survival, 16%) in those w ho took no further antiretroviral therapy, 353 days in those who took nucleoside reverse transcriptase inhibitors but no protease inhibitors (n = 34; 95% Cl, 289-418; 1-year survival, 50%), and 914 days in thos e who took a protease inhibitor (n = 24; 95% Cl, 768-1059; 1-year surv ival, 83%; P < 0.0001). Multivariate analysis showed that the stronges t independent predictor of improved survival was having ever received a protease inhibitor after CMVR (relative risk of death, 0.063; 95% Cl , 0.027-0.149; P < 0.0001). Conclusions: The use of HIV protease inhib itors in combination antiretroviral therapy has been associated with a marked increase in the survival of patients with CMVR. (C) 1998 Lippi ncott-Raven Publishers.