J. Deayton et al., Loss of cytomegalovirus (CMV) viraemia following highly active antiretroviral therapy in the absence of specific anti-CMV therapy, AIDS, 13(10), 1999, pp. 1203-1206
Objective: To determine the effect of highly active antiretroviral therapy
(HAART) on cytomegalovirus (CMV) viraemia and retinitis in patients at high
risk of disease.
Design: Sixteen patients with CMV viraemia, but no evidence of end organ di
sease at the time of first receipt of HAART including a protease inhibitor,
were studied. No patient had ever received specific anti-CMV therapy.
Methods: CMV load in blood was measured using quantitative competitive PCR
at baseline and for a median follow-up of 21 months. Regular ophthalmologic
al screening for retinitis was conducted throughout the study period.
Results: All 16 patients became CMV negative by PCR following the commencem
ent of HAART. CMV loads prior to treatment ranged From 2.0 x 10(3) to 4.1 x
10(6) copies/ml (median, 7.6 x 10(4) copies/ml). The median time to becomi
ng PCR negative was 13.5 weeks (range, 5-40 weeks). Fourteen patients remai
ned CMV negative throughout follow-up. CMV viraemia recurred in two patient
s; these individuals were indistinguishable with respect to either baseline
parameters or response to antiretroviral therapy. None of the 16 patients
developed CMV retinitis.
Conclusions: HAART including a protease inhibitor can result in the complet
e suppression of CMV viraemia, an effect not previously observed in HIV-inf
ected patients in the absence of specific anti-CMV therapy. This response c
orrelated with protection against CMV retinitis in a group of patients at h
igh risk of development of disease. These results help to explain why the n
atural history of CMV disease has altered since the introduction of such th
erapeutic regimens. (C) 1999 Lippincott Williams & Wilkins.