Douglas A Jabs1, Alka Ahuja2, Mark L Van Natta2, Alice T Lyon3, Steven Yeh4, Ronald Danis5. 1. Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Center for Clinical Trials, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: douglas.jabs@mssm.edu. 2. Center for Clinical Trials, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. 3. Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 4. Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia. 5. Department of Ophthalmology, University of Wisconsin, Madison, Wisconsin.
Abstract
PURPOSE: To describe the long-term outcomes of patients with cytomegalovirus (CMV) retinitis and AIDS in the modern era of combination antiretroviral therapy. DESIGN: Prospective, observational cohort study. PARTICIPANTS: Patients with AIDS and CMV retinitis. METHODS: Immune recovery, defined as a CD4+ T-cell count >100 cells/μl for ≥3 months. MAIN OUTCOME MEASURES: Mortality, visual impairment (visual acuity <20/40), and blindness (visual acuity ≤20/200) on logarithmic visual acuity charts and loss of visual field on quantitative Goldmann perimetry. RESULTS: Patients without immune recovery had a mortality of 44.4/100 person-years (PYs) and a median survival of 13.5 months after the diagnosis of CMV retinitis, whereas those with immune recovery had a mortality of 2.7/100 PYs (P < 0.001) and an estimated median survival of 27.0 years after the diagnosis of CMV retinitis. The rates of bilateral visual impairment and blindness were 0.9 and 0.4/100 PYs, respectively, and were similar between those with and without immune recovery. Among those with immune recovery, the rate of visual field loss was approximately 1% of the normal field per year, whereas among those without immune recovery it was approximately 7% of the normal field per year. CONCLUSIONS: Among persons with CMV retinitis and AIDS, if there is immune recovery, long-term survival is likely, whereas if there is no immune recovery, the mortality rate is substantial. Although higher than the rates in the population not infected by human immunodeficiency virus, the rates of bilateral visual impairment and blindness are low, especially when compared with rates in the era before modern antiretroviral therapy.
PURPOSE: To describe the long-term outcomes of patients with cytomegalovirus (CMV) retinitis and AIDS in the modern era of combination antiretroviral therapy. DESIGN: Prospective, observational cohort study. PARTICIPANTS: Patients with AIDS and CMV retinitis. METHODS: Immune recovery, defined as a CD4+ T-cell count >100 cells/μl for ≥3 months. MAIN OUTCOME MEASURES: Mortality, visual impairment (visual acuity <20/40), and blindness (visual acuity ≤20/200) on logarithmic visual acuity charts and loss of visual field on quantitative Goldmann perimetry. RESULTS:Patients without immune recovery had a mortality of 44.4/100 person-years (PYs) and a median survival of 13.5 months after the diagnosis of CMV retinitis, whereas those with immune recovery had a mortality of 2.7/100 PYs (P < 0.001) and an estimated median survival of 27.0 years after the diagnosis of CMV retinitis. The rates of bilateral visual impairment and blindness were 0.9 and 0.4/100 PYs, respectively, and were similar between those with and without immune recovery. Among those with immune recovery, the rate of visual field loss was approximately 1% of the normal field per year, whereas among those without immune recovery it was approximately 7% of the normal field per year. CONCLUSIONS: Among persons with CMV retinitis and AIDS, if there is immune recovery, long-term survival is likely, whereas if there is no immune recovery, the mortality rate is substantial. Although higher than the rates in the population not infected by human immunodeficiency virus, the rates of bilateral visual impairment and blindness are low, especially when compared with rates in the era before modern antiretroviral therapy.
Authors: John H Kempen; Douglas A Jabs; Laura A Wilson; James P Dunn; Sheila K West; James Tonascia Journal: Clin Infect Dis Date: 2003-10-14 Impact factor: 9.079
Authors: C D Holtzer; M A Jacobson; W K Hadley; L Huang; H D Stanley; R Montanti; M K Wong; J D Stansell Journal: AIDS Date: 1998-10-01 Impact factor: 4.177
Authors: Nathan Congdon; Benita O'Colmain; Caroline C W Klaver; Ronald Klein; Beatriz Muñoz; David S Friedman; John Kempen; Hugh R Taylor; Paul Mitchell Journal: Arch Ophthalmol Date: 2004-04
Authors: Ole Kirk; Peter Reiss; Caterina Uberti-Foppa; Markus Bickel; Jan Gerstoft; Christian Pradier; Ferdinand W Wit; Bruno Ledergerber; Jens D Lundgren; Hansjakob Furrer Journal: Ann Intern Med Date: 2002-08-20 Impact factor: 25.391
Authors: Janet T Holbrook; Douglas A Jabs; David V Weinberg; Richard Alan Lewis; Matthew D Davis; Dorothy Friedberg Journal: Arch Ophthalmol Date: 2003-01
Authors: Mrinali P Gupta; Lisa R Koenig; Ekaterina Doubrovina; Aisha Hasan; Parastoo B Dahi; Richard J O'Reilly; Guenther Koehne; Anton Orlin; Robison V Paul Chan; Donald J D'Amico; Susanna S Park; Bryn M Burkholder; Szilárd Kiss Journal: Ophthalmol Retina Date: 2021-04-20