Treating HIV-associated cytomegalovirus retinitis with oral valganciclovir and intra-ocular ganciclovir by primary HIV clinicians in southern Myanmar: a retrospective analysis of routinely collected data

Jillian Murray,Iza Ciglenecki,Adelene Hilbig,Kyi Pyar Soe,Theint Thida Soe,Win Le Shwe Sin Ei

doi:10.1186/s12879-020-05579-2

Abstract

BackgroundCytomegalovirus retinitis (CMVR) is an opportunistic infection in HIV-infected people. Intraocular or intravenous ganciclovir was gold standard for treatment; however, oral valganciclovir replaced this in high-income countries. Low- and middle-income countries (LMIC) frequently use intraocular injection of ganciclovir (IOG) alone because of cost.MethodsRetrospective review of all HIV-positive patients with CMVR from February 2013 to April 2017 at a Médecins Sans Frontièrs HIV clinic in Myanmar. Treatment was classified as local (IOG) or systemic (valganciclovir, or valganciclovir and IOG). The primary outcome was change in visual acuity (VA) post-treatment. Mortality was a secondary outcome.ResultsFifty-three patients were included. Baseline VA was available for 103 (97%) patient eyes. Active CMVR was present in 72 (68%) eyes. Post-treatment, seven (13%) patients had improvement in VA, 30 (57%) had no change, and three (6%) deteriorated. Among patients receiving systemic therapy, four (12.5%) died, compared with five (24%) receiving local therapy (p = 0.19).ConclusionsOur results from the first introduction of valganciclovir for CMVR in LMIC show encouraging effectiveness and safety in patients with advanced HIV. We urge HIV programmes to include valganciclovir as an essential medicine, and to include CMVR screening and treatment in the package of advanced HIV care.

Highlights

Cytomegalovirus retinitis (CMVR) is an opportunistic infection in Human immunodeficiency virus (HIV)-infected people
Cytomegalovirus (CMV) is a late-stage opportunistic infection (OI) in people living with HIV/Acquired immunodeficiency syndrome (AIDS), causing retinitis and extra-ocular end-organ disease, and is associated with increased mortality in HIV cohorts [1,2,3]
CMVR is uncommon in high-income countries (HIC) following universal introduction of AIDS in the preantiretroviral therapy (ART)

Summary

Introduction

Cytomegalovirus retinitis (CMVR) is an opportunistic infection in HIV-infected people. Cytomegalovirus (CMV) is a late-stage opportunistic infection (OI) in people living with HIV/AIDS, causing retinitis and extra-ocular end-organ disease, and is associated with increased mortality in HIV cohorts [1,2,3]. CMVR in resource-limited settings is a neglected disease, lacking access to screening, diagnosis and treatment [1]. It has been shown that HIV clinicians can be trained to safely perform CMVR screening, diagnosis and treatment, this still requires education and access to specific equipment, including an indirect ophthalmoscope [10]. Provision of such programmes remains limited to HIV clinics supported by non-government organizations (NGOs) [1]

Methods

Results

Conclusion