RISK OF DEVELOPING CMV RETINITIS FOLLOWING NONOCULAR CMV END-ORGAN DISEASE IN AIDS PATIENTS

Aim-To describe the risk of developing cytomegalovirus (CMV) retinitis after a first episode of extraocular CMV disease in AIDS patients. Me thods-A review of the clinical records of 20 AIDS patients, without CM V retinitis, with histologically confirmed extraocular CMV disease, wa s performed. The main outcome measures were occurrence of CMV retiniti s, time to development of CMV retinitis, relation to maintenance thera py, and survival. Results-A CMV retinitis was diagnosed in 17 of 20 (8 5%) patients with an immunohistologically confirmed diagnosis of extra ocular CMV disease after a mean follow up of 6.4 months. Four patients received maintenance therapy. Three of them developed retinitis after a mean of 9.6 months (range 2-16 months). Sixteen did not receive mai ntenance and retinitis was diagnosed in 14 of them after a mean of 5.7 months (range 2-11 months). Mean survival was 9.9 months after the di agnosis of extraocular disease, and 4.5 months after the diagnosis of retinitis. In the four patients receiving maintenance therapy, mean su rvival was 11.5 months, and in the 16 other patients mean survival was 9.5 months. Patients did not receive protease inhibitors. Conclusion- In the preprotease inhibitor era extraocular CMV disease strongly pred isposes to the subsequent development of CMV retinitis. Although maint enance therapy did not prevent the occurrence of retinitis, the time p eriod between both events seems to lengthen considerably. In patients receiving maintenance survival is also longer.