Monitoring cytomegalovirus retinitis prevalence in an HIV-seropositive cohort: the assessment of improvements observed following the introduction of highly active antiretroviral triple therapy

This paper concerns the ophthalmic assessment of patients with acquired imm unodeficiency syndrome (AIDS) for a number of eye conditions and in particu lar cytomegalovirus (CMV) retinitis. CMV has been the most common opportuni stic infection associated with AIDS and the leading cause of blindness amon g AIDS patients. There have been early indications of-a widespread fall in CMV prevalence internationally following the introduction of a new highly a ctive antiretroviral triple (HAART) therapy. Our study sought to assess the position for Ireland. Our cohort was the entire population of stage IV AID S patients attending the country's leading referral centre. The total numbe r of patients examined was 167 and the period of examination was 1 May 1995 to 30 April 1997. HAART was introduced in March 1996, so the data permitte d a 'before and after' comparison of various clinical findings. The inciden ce of new CMV cases was found to be 4 among the 102 patients examined in th e first 12-month period and one among 107 patients examined in the second 1 2-month period. There were accompanying declines in HIV-related noninfectio us retinal vasculopathy (HIVR), keratitis and other conditions. The finding s are promising, but we argue that caution is needed in assessing long-term trends. In the paper we discuss a number of methodological issues in the c ollection and analysis of the clinical data and in the interpretation of re sults.