Characteristics of patients with cytomegalovirus retinitis in the era of highly active antiretroviral therapy

Abstract

PURPOSE: To describe the characteristics of patients with AIDS and cytomegalovirus retinitis in the era of highly active antiretroviral therapy (HAART). METHODS: Prospective cohort study. Baseline (enrollment) data were compared between patients with newly diagnosed cytomegalovirus retinitis (incident cases) and those with previously diagnosed cytomegalovirus retinitis (prevalent cases). RESULTS: As of December 31, 2000, 45 incident and 200 prevalent cases had been enrolled. Among prevalent cases, the median time from cytomegalovirus retinitis diagnosis was 2.9 years. Incident cases were more likely than prevalent cases to be women (35.4% vs 15.3%, P = .001), African American (45.4% vs 20.4%, P = .002), and uninsured (29.6% vs 7.6%, P < .001). Incident cases were less likely than prevalent cases to be on HAART (51.2% vs 77.6%, P = .001) and to have had an immunologic response to HAART (increase in CD4 + T-cell count to > 100 cells/μl) (12.2% vs 57.5%, P < .001). The median CD4 + T-cell count at enrollment among incident cases was 17 cells/μl and among prevalent cases was 159 cells/μl ( P < .001). Immune recovery uveitis had been diagnosed in 15.5% of the prevalent cases. Sixty-three percent of prevalent cases were not on anticytomegalovirus therapy. CONCLUSIONS: There is a population of patients with previously diagnosed and longstanding cytomegalovirus retinitis who have experienced immune recovery as a consequence of HAART and are no longer receiving anticytomegalovirus therapy. There are demographic differences between incident and prevalent cases that may reflect the evolution of the AIDS epidemic and differences in utilization of health care services.