CMVR diagnoses and progression of CD4 cell counts and HIV viral load measurements in HIV patients on HAART
Hadi J Zambarakjia, Roger B Newsonb, Suzanne M Mitchella
a Department of
Ophthalmology, Chelsea and Westminster Hospital, London, UK, b Department of
Epidemiology and Public Health, Division of Primary Care and Population
Sciences, Imperial College School of Medicine, London, UK
Correspondence to: Miss Suzanne M Mitchell, Ophthalmology Department, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK s.mitchell{at}doctors.org.uk
Accepted for publication 22 November 2000
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 × 106/l.
METHODSA longitudinal
cohort study of 1292 patients. CD4 cell counts and HIV viral load
measurements were obtained before commencing therapy, at 3 months, 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 × 106/l. CMVR adverse event (AE) rates per 100 person days at
risk were calculated for the subgroup with CMVR and baseline CD4 cell counts <100 cells × 106/l.
RESULTS1292 patients
were started on HAART. 8% of patients had CD4 counts <50 cells × 106/l and 40% had detectable HIV viral load at last follow
up. The prevalence of CMVR for the subgroup with baseline CD4 <100
cells × 106/l was 10%. For those with baseline CD4 <100
cells × 106/l, the mean CMVR AE rate was greatest during
the first 6 months of follow up after HAART commencement (p <0.003).
The mean AE rate per 100 person days at risk was 0.36 (95% CI 0.167 to
0.551) before starting HAART, and 0.14 (95% CI 0.085 to 0.199) after starting HAART (p = 0.03).
CONCLUSIONSHAART
significantly prolongs the disease-free intervals in patients with
pre-existing disease but recurrences persist within the first 6 months
of starting therapy. AE were absent beyond 18 months of follow up in
all patients including those with persistently low CD4 counts and
detectable HIV viral load indicating clinical immunorestoration. New
methods for monitoring the response to therapy are needed to identify
those at risk.
© 2001 by British Journal of Ophthalmology
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Br. J. Ophthalmol. 2001 85: 766.[Extract] [Full Text] [PDF]
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