Anterior uveitis associated with intravenous cidofovir use in patients with cytomegalovirus retinitis

Aim-Intravenous cidofovir is used to treat cytomegalovirus (CMV) retinitis, and has been reported to cause anterior uveitis. Relations were sought bet ween this complication and patient characteristics that might help predict its occurrence. Methods-17 patients with AIDS and CMV retinitis who were treated with intra venous cidofovir were identified, and the following data collected in a ret rospective chart review: demographic characteristics, duration of CMV retin itis, retinal lesion characteristics, dose and duration of cidofovir therap y, tests of renal function, CD4+ T lymphocyte counts, visual acuity, intrao cular pressure, iris colour, history of diabetes mellitus, and use of conco mitant medications. Case-control analyses were performed to determine risk factors for developing cidofovir associated uveitis. Results-Anterior uveitis characterised by pain, ciliary injection, and decr eased visual acuity occurred in 10 patients (59%). Median interval to devel opment of uveitis was II doses of cidofovir. Symptoms developed 4.4 (SD 2.5 ) days (median 3.5) after an infusion of cidofovir. Patients who developed uveitis had a significantly greater rise in CD4+ T lymphocyte count while r eceiving cidofovir (68.4 (75.7) x10(6)/l versus 5.0 (0.6) x10(6)/l, (p = 0. 04)). By stepwise linear regression, this factor accounted for 33% (p = 0.0 3) of the effect of developing uveitis. Mean follow up time, intraocular pr essure decline during cidofovir therapy, serum creatinine and urine protein concentrations, and rates of protease inhibitor use were not significantly different between patients who developed uveitis and those who did not. Uv eitis responded to topical corticosteroids and cycloplegia. Conclusion-Anterior uveitis in patients receiving intravenous cidofovir the rapy may be related to improving immune function. The uveitis responds to t reatment and may not preclude continuation of cidofovir.