Long-term follow-up of a cohort of HIV-infected patients who discontinued maintenance therapy for cytomegalovirus retinitis

HIV Clinical Trials
Sharon L WalmsleyJill Hopkins

Abstract

To determine the long-term safety of discontinuation of maintenance therapy for cytomegalovirus retinitis (CMVR) and to identify predictors for relapse. This was a prospective cohort study. Patients with treated CMVR who responded to HAART were followed by ophthalmologic assessment, markers for CMV replication (blood and urine cultures, CMV antigenemia, CMV DNA by PCR), and in vitro lymphoproliferative responses to CMV and other antigens after discontinuation of CMVR maintenance therapy. 23 patients were followed a median of 34 (range, 5-61) months. Median CD4 count was 321/mm3 at enrollment and 395/mm3 at last follow-up. HIV RNA was <50 copies/mL in 78% of patients at enrollment and 65% at last follow-up. One CMVR reactivation occurred at 12 months at a CD4 count of 395/mm3 (21%) and HIV RNA <50 copies/mL. Urine cultures were a poor predictive marker for reactivation. Other CMV replication markers had good negative predictive value. 96% of patients had a good lymphoproliferative response to CMV antigen in vitro. Maintenance therapy for CMVR can safely be discontinued in patients who have responded to HAART. Combining our results with the published literature, the risk of reactivation is estimated at 0.016 per person year of fo...Continue Reading

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Citations

May 14, 2010·Clinical Ophthalmology·Michael W Stewart
Jun 13, 2012·Current Infectious Disease Reports·Lisa Barrett, Sharon Walmsley
Feb 20, 2008·American Journal of Ophthalmology·Gary N Holland
Jul 12, 2011·American Journal of Ophthalmology·Janet T HolbrookUNKNOWN Studies of Ocular Complications of AIDS (SOCA) Research Group
Sep 24, 2020·Ocular Immunology and Inflammation·Juliana WonsJustus G Garweg
Jan 8, 2020·Microorganisms·Monique MunroAnn-Marie Lobo-Chan

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