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Cytomegalovirus retinitis in patients positive for HIV a significant global problem
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CHICAGO — The impact of retinitis secondary to cytomegalovirus infection in patients positive for HIV has been largely ameliorated through the introduction of highly active anti-retroviral therapy, but the unique interaction of the causative pathogen in immune compromised individuals makes the condition a harbinger of potentially deadly outcomes.
 Douglas A. Jabs |
Cytomegalovirus (CMV) acts synergistically with HIV; in vitro studies demonstrate that the two are transactive, and in clinical experience, it is known that CMV attacks immune processes already ravaged by the presence of HIV, Douglas A. Jabs, MD, MBA, said during the Jackson Memorial Lecture at the joint meeting of the American Academy of Ophthalmology and Middle East African Council of Ophthalmology.
The introduction of HAART therapy in the 1990s proffered a significant reduction in both HIV and CMV associated mortality and about a 90% reduction in CMV retinitis in the United States. Effective HAART enables immune reconstitution to the point that CMV therapy can actually be discontinued after about 6 months, Dr. Jabs said.
Before cessation of therapy, the Vitrasert implant (Bausch + Lomb), which delivers sustained release ganciclovir, is highly effective in stemming CMV retinitis, but must be augmented with oral therapy to account for the systemic consequences of CMV infection. However, local ganciclovir therapy has been associated with both resistance, as well as immune recovery uveitis — especially in cases where large CMV lesions are present.
Although effective in the United States, HAART therapy remains inaccessible in many portions of the world, and so while CMV retinitis concomitant with HIV infection seems a rare problem, the global impact is still very significant, Dr. Jabs said.
- Disclosure: Dr. Jabs has no direct financial interest in the products discussed in this article, nor is he a paid consultant for any companies mentioned.