Outcome of AIDS-associated cytomegalovirus colitis in the era of potent antiretroviral therapy

The effect of protease inhibitors (PIs) on the outcome of AIDS-associated c ytomegalovirus (CMV) colitis is unknown. The aim of this study was to deter mine the impact of PIs on the recurrence of CMV disease and long-term survi val in a large cohort of acquired immunodeficiency syndrome (AIDS) patients with CMV colitis. We reviewed the medical records of 152 AIDS patients who were diagnosed with CMV colitis by colonoscopy between January 1992 and Ja nuary 1997 at Bellevue Hospital (New York, NY, U.S.A.). Follow-up data were obtained from chart review and direct telephone contact. A complete respon se to ganciclovir and/or foscarnet therapy was seen in 87.0% of the patient s. Recurrence of CMV colitis occurred in 53.1% of patients and was signific antly less common in those who received maintenance therapy (36.1% vs. 56.7 %; p = 0.03) and in those who were treated with PIs (22.8% vs. 71.9%; p < 0 .001). During follow-up, 69.3% of patients died. Multivariate analysis usin g Cox regression showed that mortality was increased in patients with recur rent CMV colitis (relative risk [RR] of death, 1.7; 95% CI, 1.1-2.6; p = 0. 02) and comorbid disease (RR, 1.5; 95% CI, 1.1-2.2; p = 0.02), and decrease d in those who were treated with PIs (RR, 0.42; 95% CI, 0.3-0.7; p = 0.001) . The median survival was 71 weeks and was significantly longer in patients who were treated with PIs than in those who did not receive these potent a ntiretroviral medications (99 vs. 51 weeks; p < 0.001). PIs significantly i mprove the outcome of AIDS-associated CMV colitis.