FOSCARNET-GANCICLOVIR CYTOMEGALOVIRUS RETINITIS TRIAL .5. CLINICAL-FEATURES OF CYTOMEGALOVIRUS RETINITIS AT DIAGNOSIS

PURPOSE: To examine associations of systemic and ocular characteristic s with severity of cytomegalovirus (CMV) retinitis at time of diagnosi s and to compare ocular characteristics of eyes with and without CMV r etinitis. METHODS: Eleven clinical centers, a data coordinating center , and a fundus photograph reading center participated in a randomized, controlled, multicenter clinical trial comparing foscarnet and gancic lovir as primary therapy for previously untreated CMV retinitis in 240 patients with AIDS. RESULTS: The systemic characteristics marginally associated with the percentage of retina affect ed by CMV in a patient 's worse eye at diagnosis were chronic fever, weight loss, and number of HIV-related illnesses. A positive CMV blood culture at diagnosis wa s similarly associated with bilateral disease. Laboratory measures of disease did not correlate well with measures of CMV retinitis severity . Many eyes with CMV retinitis had no or minimal lesion hemorrhage, bu t most had signs of inflammation. Patients often reported visual sympt oms for involved eyes. The worse eyes (the eye with lesions covering t he most retinal area) of patients with bilateral disease had greater r etinal involvement, more lesions, and fewer degrees of visual field th an did involved eyes of patients with unilateral disease. Visual sympt oms, inflammation, indolent retinitis, and hemorrhagic lesions were as sociated with a greater percentage of retina affected by CMV. CONCLUSI ONS: The findings support viremia as a mechanism of spread for untreat ed disease. Visual symptoms and signs of ocular inflammation were indi cators both of the presence of CMV retinitis and of greater extent of retinal area covered by CMV retinitis lesions.