Jl. Casado et al., Incidence and risk factors for developing cytomegalovirus retinitis in HIV-infected patients receiving protease inhibitor therapy, AIDS, 13(12), 1999, pp. 1497-1502
Objective: To assess the incidence and risk factors for cytomegalovirus (CM
V) retinitis in HIV-infected patients who initiated protease inhibitor-cont
aining antiretroviral therapy.
Design and setting: Prospective, multicentre study.
Patients: A cohort of 172 HIV-infected patients with a CD4 cell count below
100 x 10(6) cells/l at the time of protease inhibitor introduction.
Main outcome measures: Confirmed CMV retinitis and mortality, according to
CD4 cell count, HIV load, and CMV viraemia.
Results: The cumulative incidence of CMV retinitis was 5% at 1 year and 6%
at 2 years. Only a positive CMV polymerase chain reaction (PCR) test at the
rapy initiation was significantly associated with the development of diseas
e (relative hazard, 4.41; 95% confidence interval, 2.12-8.93; P < 0.00001).
The 12-month Kaplan-Meier CMV retinitis event rate was 38% in patients who
were CMV PCR positive compared with 2% in those who were CMV PCR-negative
(P < 0.001). Mean CMV load was significantly higher in those individuals wh
o went on to develop CMV retinitis (3700 versus 384 copies/ml, P = 0.002).
Only 2% of patients remained CMV PCR-positive after 3 months of protease in
hibitor therapy, and CMV viraemia was not associated with a worse therapy r
esponse or shorter survival. Transient CMV positivity without a higher risk
of disease was observed in 7% of patients at the first month on therapy.
Conclusions: Protease inhibitor-containing antiretroviral therapy significa
ntly reduces the incidence of CMV viraemia and disease. Although a positive
CMV PCR test identifies those patients on therapy at highest risk of CMV r
etinitis, it is not associated with an increased risk of death or a worse r
esponse to protease inhibitor therapy. (C) 1999 Lippincott Williams & Wilki
ns.