REGRESSION OF CYTOMEGALOVIRUS RETINITIS ASSOCIATED WITH PROTEASE-INHIBITOR TREATMENT IN PATIENTS WITH AIDS

PURPOSE: To report the observation that antiretroviral therapy that in cludes a protease inhibitor can induce the regression of cytomegalovir us retinitis without requiring specific anticytomegalovirus drug thera py. METHODS: We examined the fundi of four patients with advanced acqu ired immunodeficiency syndrome (AIDS) who were placed on highly active antiretroviral therapy consisting of two nucleoside analogs and a pro tease inhibitor. The combined medications resulted in increased CD4(+) T lymphocyte counts and decreased load of human immunodeficiency viru s (HIV-1). A prospective evaluation of the effect of these medications on an active cytomegalovirus retinitis lesion was con ducted in one p atient. Retinal lesions were documented with fundus photography. RESUL TS: None of these patients received specific anticytomegalovirus medic ations. The average baseline CD4(+) T-lymphocyte count was 33 cells pe r mu l (range, 4 to 88 cells per mu l) and increased an average of 118 .5 cells per mu l (range, 66 to 185 cells per mu l). Average baseline plasma HIV-1 viral loads (HIV-1-RNA copies per mi) decreased 1.46 log units (range, 0.65 to 2.93 log units). In one patient, posterior progr ession (border advancement toward the posterior pole) of a cytomegalov irus retinitis lesion decelerated over time and stopped. Three other p atients on initial examination had areas of retinal scarring consisten t with healed cytomegalovirus retinitis. CONCLUSIONS: The addition of an HIV-1 protease inhibitor in the treatment of AIDS may lead to compl ete regression of cytomegalovirus retinitis without specific anticytom egalovirus medications. This effect may be related to reduced HIV-1 lo ads, a possible direct drug effect, an increase in CD4(+) T-lymphocyte counts, or other associated changes in immune status.