Changes in the natural history of cytomegalovirus retinitis following the introduction of highly active antiretroviral therapy

Objective: To determine the effect of highly active antiretroviral therapy (HAART) on the natural history of cytomegalovirus (CMV) retinitis. Design and participants: Retrospective analysis of 103 consecutive patients diagnosed with CMV retinitis between 1990 and 1998. Setting: Specialist HIV medicine department of a London hospital. Main outcome measures: Incidence of CMV retinitis, time to death following diagnosis, episodes of progression, incidence of inflammatory complications . The date of first use of HAART was January 1995. Data were censored on 30 lune 1998. Results: The incidence of CMV retinitis has declined dramatically following the introduction of HAART. Survival following CMV retinitis increased from a median of 0.65 years prior to 1995 to a median of 1.07 years after this date (P = 0.004). In multivariate analyses HAART was independently associat ed with improved survival (P = 0.02) and the association with year of diagn osis was no longer significant, suggesting that this effect is predominantl y due to HAART. None of the patients receiving HAART experienced progressio n after 6 months of treatment. Complications of retinitis such as retinal d etachment, uveitis and optic atrophy occurred in 39% of patients. The rare inflammatory complications of vitritis and cystoid macular oedema ocurred o nly in recipients of HAART. Conclusions: The introduction of HAART has had a major impact on the natura l history of CMV retinitis with improved survival time and decreased risk o f progression following diagnosis. However, immune reconstitution may be as sociated with inflammatory complications which can result in significant vi sual loss in the absence of active CMV disease. (C) 2000 Lippincott William s & Wilkins.