Mortality associated with resistant cytomegalovirus among patients with cytomegalovirus retinitis and AIDS.

OBJECTIVE

To evaluate the effect of drug-resistant cytomegalovirus (CMV) on survival among patients with CMV retinitis.

DESIGN

Prospective cohort study during 1993 to 2003.

PARTICIPANTS

We included 266 patients with AIDS and newly diagnosed CMV retinitis treated with either ganciclovir or foscarnet.

METHODS

Data on ganciclovir and foscarnet resistance were obtained from blood and urine specimens collected at regular, predetermined intervals. The effect of resistant CMV on mortality was evaluated with a time-dependent Cox proportional hazard model.

MAIN OUTCOME MEASURES: Mortality.

RESULTS

The median survival of the entire cohort was 12.6 months. Analysis of risk factors for mortality demonstrated that resistant CMV was associated with an increased mortality (hazard ratio, 1.65; 95% confidence interval, 1.05-2.56; P = 0.032). Among the other parameters tested, only time since AIDS diagnosis was associated significantly with mortality, with a hazard ratio of 1.10 per year since AIDS diagnosis (P = 0.001).

CONCLUSIONS

Resistant CMV is associated with increased mortality among patients with AIDS being treated for CMV retinitis.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.