CMVR diagnoses and progression of CD4 cell counts and HIV viral load measurements in HIV patients on HAART

Aim-To assess the impact of highly active antiretroviral therapy (HAART) on the prevalence and progression of CMV retinitis (CMVR) among AIDS patients with baseline CD4 cell counts < 100 cells x 10(6)/l. Methods-A longitudinal cohort study of 1292 patients. CD4 cell counts and H IV viral load measurements were obtained before commencing therapy, at 3 mo nths, 1 year, 2 years, and at last follow up. The CMVR prevalence rate was measured for the subgroup with baseline CD4 cell counts < 100 cells x 10(6) /l. CMVR adverse event (AE) rates per 100 person days at risk were calculat ed for the subgroup with CMVR and baseline CD4 cell counts < 100 cells x 10 (6)/l. Results-1292 patients were started on HAART. 8% of patients had CD4 counts < 50 cells x 10(6)/l and 40% had detectable HIV viral load at last follow u p. The prevalence of CMVR for the subgroup with baseline CD4 < 100 cells x 10(6)/l was 10%. For those with baseline CD4 < 100 cells x 10(6)/l, the mea n CMVR AE rate was greatest during the first 6 months of follow up after HA ART commencement (p <0.003). The mean AE rate per 100 person days at risk w as 0.36 (95% CI 0.167 to 0.551) before starting HAART, and 0.14 (95% CI 0.0 85 to 0.199) after starting HAART (p = 0.03). Conclusions-HAART significantly prolongs the disease-free intervals in pati ents with pre-existing disease but recurrences persist within the first 6 m onths of starting therapy. AE were absent beyond 18 months of follow up in all patients including those with persistently low CD4 counts and detectabl e HIV viral load indicating clinical immunorestoration. New methods for mon itoring the response to therapy are needed to identify those at risk.