Highly active antiretroviral therapy-associated regression of cytomegalovirus retinitis - Long-term results in a small case series

Purpose: To report the stability of acquired immunodeficiency syndrome (AID S)-associated cytomegalovirus (CMV) retinitis lesions that have undergone r egression in the absence of specific anti-CMV medications owing to highly a ctive antiretroviral therapy (HAART)-generated immune recovery. Methods: The initial examination revealed HAART-associated regression of CM V retinitis lesions in eight subjects at two institutions. Patients were mo nitored for recurrences of CMV activity. CD4(+) T-lymphocyte counts and hum an immunodeficiency virus (HIV) loads were measured. Results: All patients had positive initial responses to HAART with an avera ge HIV load decrease of 2.26 log units (range 0.3-5.57). Mean CD4(+) T-lymp hocyte count at baseline was 45.6 (range 4-107) and increased by an average of 132.5 (range 7-266) within the first 2 to 4 months of HAART. Patients w ere observed for an average of 15.5 months (range 11-20 months). Six subjec ts had a vigorous and sustained response to therapy, achieving an average H IV load of 9,400 copies/mL (3.32 log10 decrease) and CD4(+) T-lymphocyte co unt of 158.2 cells/muL. These patients had no CMV retinitis progression. By contrast, two others who attained an average log10 decrease of only 0.48 h ad modest and short-lived increases in the CD4(+) T-lymphocyte count. These patients experienced reactivation of CMV retinitis after 5 and 7 months, r espectively. Conclusions: Regressed CMV retinitis may remain healed for long periods. Ho wever, failure of HAART to induce substantial decreases in HIV load may pre dict poor or unsustainable rises in the CD4(+) T-lymphocyte count and presa ge recurrence of CMV retinitis. Vigilance in ophthalmic examinations is esp ecially mandatory in these subjects.