IMPROVED OUTCOME OF CYTOMEGALOVIRUS RETINITIS IN AIDS PATIENTS AFTER INTRODUCTION OF PROTEASE INHIBITORS

The objective of this study was to evaluate the influence of protease inhibitor therapy on the rate of progression and survival of 17 AIDS p atients with stable Cytomegalovirus retinitis, who were receiving anti -CMV therapy. CD4(+) count, HIV load, and CMV antigenemia assay were d etermined at baseline, at the first month, and every 3 months thereaft er. Median CD4(+) count increased from 11 to 87 cells/mm(3), and media n HIV RNA level decreased from 4.96 to 3.28 log(10) copies/ml, after 6 months on therapy. Although 9 patients (53%) relapsed in a median tim e of 97 days (range, 15-152 days), no further episodes were observed d uring a median follow-up of 17 months (range, 5-18 months). Thus, the probability of remaining free of relapse was twofold higher than that observed in matched patients who did not receive protease inhibitors. Median CD4(+) count at the 3rd month was higher in those individuals w ho went on to progress (p = .03), and a positive result to a CMV antig enemia test was associated with progression of retinitis (relative haz ard, 4.45; p = .04). Survival rate was 94% at 17 months (89% increase) . Therefore, protease inhibitor therapy reduces retinitis progression and improves survival. However, the immunologic response may not provi de initial sufficient protection to avoid, or even may play a role on, early CMV progression.