Cessation of anti-cytomegalovirus maintenance therapy in AIDS patients with cytomegalovirus retinitis healed by highly active antiretroviral therapy

Background. Immune recovery of AIDS patients with cytomegalovirus (CMV) ret initis treated and healed by highly active antiretroviral therapy (HAART) i s reflected by increased CD4 cell count and decreased virus load. Due to pa rtial reconstitution of the immune status the risk of opportunistic infecti ons decreases, as well as the risk of reactivating inactive CMV retinitis. It may therefore be possible to stop anti-CMV maintenance therapy may after HAART-induced immune recovery. Patients and methods. We present six patients (nine eyes) with a follow-up of 9.5 months (range 7-12 months) after cessation of the CMV-specific maint enance therapy (five orally, one intravenously). Results. There was no reactivation of retinal CMV infection during the foll ow-up period. The virus load (<50 Eq/ml; a single value of one patient was 2047 Eq/ml) and CD4 cell counts (range 207-454/mu l; mean: 313/mu l) remain ed stable during the follow-up period, reflecting immune recovery. Conclusions. Our findings confirm the expected low risk of retinal CMV reac tivation after immune recovery in AIDS patients receiving HAART without sec ondary prophylaxis with an anti-CMV maintenance therapy. Regular ophthalmic and medical follow-up is mandatory in these patients. Cessation of mainten ance therapy represents a major improvement in quality of live in AIDS pati ents.