INCIDENCE AND EVOLUTION OF VIRAL RETINITIS IN HIV-INFECTED PATIENTS TREATED WITH HIV-PROTEASE INHIBITORS

Background Since the beginning of the use of HN-Protease Inhibitors (P I) to treat HIV-infected patients, a decrease of the incidence of extr aocular opportunistic infections has been observed. We studied the inc idence of CMV-retinitis in patients treated with a highly active antir etroviral therapy (HAART) containing PI over a mean follow-up of 12 mo nths. Methods Ninety-three HIV-infected patients treated with HAART co ntaining PI were included. The mean initial CD4+ cell-count was 54/mu l (median: 22/mu l), and the mean plasma HN-load was 5.46 log10 RNA-co pies /ml. Fundus examination was performed each month in case of a pre viously treated and controlled CMV-retinitis or if initial CD4 cells w ere below 50/mu l. In other patients, fundus examination was performed every 3 months. The mean follow-up was 362 days. Results Among the 7 patients with a previously treated and controlled CMV-retinitis, one e xperienced a progression during the study (after 163 days of PI). Amon g the 59 patients with CD4 cells below 50/mu l and without previous CM V-retinitis before the beginning of PI, 5 experienced a CMV-retinitis (mean delay after the onset of HAART: 141 days), including 2 with rela pse. When retinitis occurred CD4 cells were below 32/mu l except in on e case (147/mu l). Conclusions Compared to previously published report s, this study, showed an increase of the time to progression of previo usly treated and controlled CMV-retinitis in patients treated with PI. Considering deeply immunocompromised patients (less than 50 CD4-cells /mu l), the risk of suffering from CMV-retinitis tvas 8.5 % after 12 m onths of PI treatment Longer follow-up remains necessary to confirm th ese results.