Ophthalmology · 2004
Course of cytomegalovirus retinitis in the era of highly active antiretroviral therapy: 1. Retinitis progression.
СтатьяМногоцентровое исследованиеПоддержка службы здравоохранения СШАНазвание и аннотация: Перевод в очереди
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Jabs Douglas A, Van Natta Mark L, Thorne Jennifer E, Weinberg David V, Meredith Travis A, Kuppermann Baruch D, Sepkowitz Kent, Li Helen K, Studies of Ocular Complications of AIDS Research Group
Аннотация
PURPOSE: To describe the course of cytomegalovirus (CMV) retinitis in patients with AIDS in the era of highly active antiretroviral therapy (HAART).
DESIGN: Multicenter, prospective, observational study.
PARTICIPANTS: Two hundred seventy-one patients with AIDS and CMV retinitis.
METHODS: Follow-up every 3 months with medical history, ophthalmologic examination, laboratory testing, and fundus photographs. Photographs were evaluated for relapse of the retinitis (progression) by graders at a centralized reading center.
MAIN OUTCOME MEASURE: Retinitis progression (movement of the border of a CMV lesion > or =750 microm over a > or =750-microm front or occurrence of a new lesion one-quarter disc area or more in size).
RESULTS: The overall rate of retinitis progression was 0.10/person-year (PY); among those with CD4+ T-cell counts of <50/microl, it was 0.58/PY, compared to 0.02/PY among those with CD4+ T-cell counts of > or =200/microl (P<0.0001). In the multivariate analysis, significant risk factors for retinitis progression included a low CD4+ T-cell count, positive CMV load, longer time from AIDS diagnosis, and low Karnofsky score.
CONCLUSIONS: Compared with the rate of retinitis progression (approximately 3.0/PY) reported in the pre-HAART era, the rate of retinitis progression was reduced among patients in the HAART era, even among those with low CD4+ T-cell counts, who might be expected to behave most like patients from the pre-HAART era. However, these events also occurred among patients with high CD4+ T-cell counts and presumed immune recovery. Continued ophthalmologic follow-up of patients with immune recovery is recommended to detect early retinitis progression.
DESIGN: Multicenter, prospective, observational study.
PARTICIPANTS: Two hundred seventy-one patients with AIDS and CMV retinitis.
METHODS: Follow-up every 3 months with medical history, ophthalmologic examination, laboratory testing, and fundus photographs. Photographs were evaluated for relapse of the retinitis (progression) by graders at a centralized reading center.
MAIN OUTCOME MEASURE: Retinitis progression (movement of the border of a CMV lesion > or =750 microm over a > or =750-microm front or occurrence of a new lesion one-quarter disc area or more in size).
RESULTS: The overall rate of retinitis progression was 0.10/person-year (PY); among those with CD4+ T-cell counts of <50/microl, it was 0.58/PY, compared to 0.02/PY among those with CD4+ T-cell counts of > or =200/microl (P<0.0001). In the multivariate analysis, significant risk factors for retinitis progression included a low CD4+ T-cell count, positive CMV load, longer time from AIDS diagnosis, and low Karnofsky score.
CONCLUSIONS: Compared with the rate of retinitis progression (approximately 3.0/PY) reported in the pre-HAART era, the rate of retinitis progression was reduced among patients in the HAART era, even among those with low CD4+ T-cell counts, who might be expected to behave most like patients from the pre-HAART era. However, these events also occurred among patients with high CD4+ T-cell counts and presumed immune recovery. Continued ophthalmologic follow-up of patients with immune recovery is recommended to detect early retinitis progression.
Предметные рубрики MeSH
AIDS-Related Opportunistic InfectionsAdultAntiretroviral Therapy, Highly ActiveAntiviral AgentsCD4 Lymphocyte CountCD4-Positive T-LymphocytesCytomegalovirus RetinitisDisease ProgressionEpidemiologic StudiesFemaleFollow-Up StudiesGanciclovirHumansMaleMultivariate AnalysisProspective StudiesRecurrence