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- Title
Discontinuation of anticytomegalovirus therapy in patients with HIV infection and cytomegalovirus retinitis.
- Authors
Whitcup, Scott M.; Fortin, Eric; Whitcup, S M; Fortin, E; Lindblad, A S; Griffiths, P; Metcalf, J A; Robinson, M R; Manischewitz, J; Baird, B; Perry, C; Kidd, I M; Vrabec, T; Davey, R T Jr; Falloon, J; Walker, R E; Kovacs, J A; Lane, H C; Nussenblatt, R B; Smith, J
- Abstract
<bold>Context: </bold>Persons with cytomegalovirus (CMV) retinitis and acquired immunodeficiency syndrome (AIDS) have required lifelong anti-CMV therapy to prevent the progression of retinal disease and subsequent loss of vision.<bold>Objective: </bold>To determine whether patients who were taking highly active antiretroviral therapy (HAART) and who had stable CMV retinitis could safely discontinue anti-CMV therapy without reactivation of their retinitis or increase in human immunodeficiency virus (HIV) viral load.<bold>Design: </bold>Prospective nonrandomized interventional trial performed from July 1997 to August 1999.<bold>Setting: </bold>Clinical Center of the National Institutes of Health, Bethesda, Md.<bold>Patients: </bold>Fourteen patients with stable CMV retinitis and HIV infection and CD4+ cell counts higher than 0.1 5 x 10(9)/L and being treated with systemic anti-CMV medications and HAART.<bold>Interventions: </bold>Discontinuation of specific anti-CMV therapy.<bold>Main Outcome Measures: </bold>Reactivation of CMV retinitis, development of extraocular CMV infection, detection of CMV in blood and urine, HIV burden, immunologic function, quality of life, morbidity, and mortality.<bold>Results: </bold>Twelve (89.7%) of 14 patients had evidence of immune recovery uveitis before anti-CMV drugs were discontinued. No patient had reactivation of CMV retinitis or development of extraocular CMV disease during mean follow-up of 16.4 months (range, 8.3-22.0 months) without anti-CMV therapy. Human immunodeficiency viral load remained stable following cessation of anti-CMV medications. Blood and urine assays for CMV were briefly positive in 9 patients but did not predict reactivation of CMV disease. Worsening immune recovery uveitis was associated with a substantial (>3 lines) vision loss in 3 patients.<bold>Conclusions: </bold>Maintenance anti-CMV medications were safely stopped in those patients who had stable CMV retinitis and elevated CD4+ cell counts and who were taking HAART. The study demonstrates that immune recovery following potent antiretroviral therapy is effective in controlling a major opportunistic infection, even in patients with a history of severe immunosuppression.
- Subjects
CYTOMEGALOVIRUS disease treatment; RETINITIS pigmentosa
- Publication
JAMA: Journal of the American Medical Association, 1999, Vol 282, Issue 17, p1633
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.282.17.1633