CMV retinitis in the era of HAART

Since 1996, major advances in the treatment of AIDS have markedly changed t he incidence and the prognosis of CMV retinitis. Highly active antiretrovir al therapy (HAART) is a combination of nucleoside reverse transcriptase inh ibitors and protease inhibitors. This new therapeutic strategy is highly ef ficient in reducing the HIV viral load and increasing CD4+ T-lymphocyte cou nt. These biological effects are associated with an improvement of immune f unctions. Clinically, the completely quiescent CMV retinitis and the unusua l prolonged relapse-free interval suggest a certain restoration of immune f unctions, making possible the discontinuation of maintenance therapy. For m ost authors, the decision to stop anti-CMV maintenance therapy is based on a CD4+ cell count >100 cells/mu l with a low HIV viral load for at least fo ur months. The improvement of CMV retinitis on HAART may also be associated with an intraocular inflammation called immune recovery vitritis. For some patients, this vitritis may be associated cystoid macular edema and an epi retinal membrane responsible for visual loss.