Cytomegalovirus Retinitis Outcomes in HIV-Infected and Non–HIV Patients at a Tertiary Care Center

Abstract

Purpose: To describe cytomegalovirus (CMV) retinitis outcomes in HIV-infected and non–HIV patients at a tertiary care center. Participants: Twenty-six eyes from 20 patients with active CMV retinitis were included in this study. Patients were immunocompromised due to HIV or secondary to immunosuppressive therapy for malignancy and organ transplantation. Methods: This is a retrospective, observational study of patients with newly diagnosed active CMV retinitis. The main outcomes included the incidence of visual acuity loss, the loss of visual acuity to 20/200 or worse, and the loss of 3 lines of vision or more. Secondary outcomes included the identification of risk factors for these visual results and the development of various complications such as retinal detachment (RD) and cataract formation. Results: In all, 51.9% (n = 14) of eyes lost vision from baseline at most recent follow-up and 34.6% (n = 9) lost 3 lines or more of vision, 34.6% (n = 9) of the eyes lost significant vision at most recent follow-up and had a final vision of 20/200 or worse, and 22.73% of phakic eyes underwent cataract surgery, whereas 23.1% (n = 6) of eyes developed RD. Patients presenting with a CD4+ T-cell count <100 cells/µL were more likely to lose vision when compared to those presenting with a count >100 cells/µL ( P = .0440). Although not statistically significant, patients who were immunocompromised due to HIV were less likely to lose 3 or more lines of vision ( P = .1881) and less likely to have a final visual acuity of 20/200 or worse ( P = .1881), when compared to patients who were immunocompromised due to other reasons. There was also a nonsignificant trend for eyes affected by a larger area of CMV retinitis at baseline (>25%) to have a final visual acuity of 20/200 or worse when compared to eyes with CMV retinitis involving <25% of the total retina ( P = .089). We did not detect trends or associations between any other risk factors tested and visual outcomes. We did not identify an association between HIV status and baseline area or zone affected by CMV retinitis. Conclusions: Our cohort demonstrated that CMV retinitis remains a vision-threatening problem among patients who are immunocompromised due to HIV or other conditions. Immunocompromised patients are still at a significant risk of vision loss and complications from CMV retinitis and should be managed by a multidisciplinary team of physicians. In the immediate future, improved therapies are necessary to achieve immune recovery in patients, particularly for those remaining chronically immunosuppressed.