Risk of developing CMV retinitis following non-ocular CMV end organ disease in AIDS patients
- Frank D Verbraaka,
- Gerardus J van den Horna,
- Jan T M van der Meerb,
- Darius Paydafarb,
- Fibo J W ten Katec,
- Pauline M E Wertheim-van Dillend,
- Aize Kijlstraa,e
- aDepartment of Ophthalmology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands, bDepartment of Internal Medicine, Division of Infectious diseases, Tropical medicine, and AIDS, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands, cLaboratory of Pathology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands, dLaboratory of Medical Microbiology, Department of Clinical Virology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands, eDepartment of Ophthalmo-Immunology, the Netherlands Ophthalmic Research Institute, Amsterdam, Netherlands
- F D Verbraak, MD, Academic Medical Centre, University of Amsterdam, Department of Ophthalmology, PO Box 22700, 1100 DE Amsterdam, Netherlands
- Accepted 29 January 1998
Abstract
AIM To describe the risk of developing cytomegalovirus (CMV) retinitis after a first episode of extraocular CMV disease in AIDS patients.
METHODS A review of the clinical records of 20 AIDS patients, without CMV retinitis, with histologically confirmed extraocular CMV disease, was performed. The main outcome measures were occurrence of CMV retinitis, time to development of CMV retinitis, relation to maintenance therapy, and survival.
RESULTS A CMV retinitis was diagnosed in 17 of 20 (85%) patients with an immunohistologically confirmed diagnosis of extraocular CMV disease after a mean follow up of 6.4 months. Four patients received maintenance therapy. Three of them developed retinitis after a mean of 9.6 months (range 2–16 months). Sixteen did not receive maintenance and retinitis was diagnosed in 14 of them after a mean of 5.7 months (range 2–11 months). Mean survival was 9.9 months after the diagnosis of extraocular disease, and 4.5 months after the diagnosis of retinitis. In the four patients receiving maintenance therapy, mean survival was 11.5 months, and in the 16 other patients mean survival was 9.5 months. Patients did not receive protease inhibitors.
CONCLUSION In the preprotease inhibitor era extraocular CMV disease strongly predisposes to the subsequent development of CMV retinitis. Although maintenance therapy did not prevent the occurrence of retinitis, the time period between both events seems to lengthen considerably. In patients receiving maintenance survival is also longer.
