Incidence of presumed cytomegalovirus retinitis in HIV-infected pediatric patients

Introduction: Large population studies of adult patients suggest an inciden ce of cytomegalovirus (CMV) retinitis as high as 19% to 20% as a late compl ication of adult HIV infection. We conducted this prospective study of a la rge cohort of HIV-infected children to determine the incidence of CMV retin itis in HIV-infected children. Methods: From January 1984 to August 1997, 1 73 HIV-infected children were followed up for an average of 55.3 months (13 -164 months). The patients were seen in the Department of Pediatrics at lea st once every 6 months. Ophthalmologic examinations were initiated when a p atient's CD4 count dropped below 50 or sooner if required for ophthalmologi c or other indications. Ophthalmologic examination was then repeated every 6 months. Results, A total of 116 (67%) of 173 patients underwent ophthalmo logic examination. Four (3.4%) of 116 patients had CMV retinitis at a mean time of 17.3 months (8-38 months) after their CD4 counts dropped below 20. None of the 4 patients with CMV retinitis had subjective visual complaints despite advanced retinitis, Three patients had-bilateral and 1 patient had unilateral CMV retinitis. Conclusions: CMV retinitis occurred infrequently in HIV-infected pediatric patients and was diagnosed only in patients with a CD4 count below 20. Routine ophthalmologic screening examinations may not be necessary in pediatric patients until the CD4 count is below 20. Becaus e children may not com plain of decreased vision, at-risk children should u ndergo frequent ophthalmologic examination.