Highly active antiretroviral therapy-related immune recovery in AIDS patients with cytomegalovirus retinitis

Objective: To characterize cytomegalovirus (CMV) retinitis in human immunod eficiency virus (HIV)-infected patients who demonstrate immune recovery whi le receiving highly active antiretroviral therapy (HAART), Design: Consecutive, noncomparative case series. Participants: Twenty-two HIV-positive patients, from two institutions, with a history of CMV retinitis, and with elevated CD4 cell counts after HAART. Main Outcome Measures: Duration of healed CMV retinitis without anti-CMV th erapy, CD4 cell count, and HIV viral load. Intervention: Discontinuation of anti-CMV therapy after persistent elevatio n of CD4 cell count over 50 cell/mm(3) (median, 161/mm(3); range, 85-408/mm (3)). Results: The median period of healed CMV retinitis without anti-CMV therapy was 72 weeks (range, 33-116 weeks). Nineteen of 22 patients were still hea led without anti-CMV therapy at study end. The three patients with CMV reti nitis progression simultaneously had HAART, fail with CD4 cell counts of 37 , 35, and 47/mm(3). Conclusions: HIV-positive patients with CMV retinitis, who demonstrate a su stained HAART-induced elevation of CD4 cell count on two consecutive counts 3 months apart and whose retinitis remains healed on anti-CMV therapy for greater than 4 months, are likely to remain healed if the anti-CMV therapy is withdrawn, It is important to monitor these patients with indirect ophth almoscopy because HAART failure may occur and allow CMV retinitis reactivat ion. (C) 2000 by the American Academy of Ophthalmology.