Journal Title : Clinical Features and CD4+ T Cells Count in AIDS Patients

with CMV Retinitis: Correlation with Mortality

Background : Cytomegalovirus (CMV) retinitis is the most common
opportunistic ocular infection in patients with acquired
immune deficiency syndrome (AIDS) and CD4 + T cell count
<50 cells/ mm. CMVR is reported in approximately 20–40%
of HIV positive patients and is the most common (90%)
cause of unilateral or bilateral blindness. The incidence of
CMV retinitis (CMVR) has decreased by 80–90% since the
development of combined antiretroviral therapy (cART)
Purpose : To explore the all-cause mortality in patients with acquired
immune deficiency syndrome (AIDS) and Cytomegalovirus
(CMV) retinitis.
Methods : This study is a retrospective review of consecutive AIDS
patients with CMVR that presented to the Communicable
Disease Center (CDC) and a tertiary referral eye care center
in Singapore, from January 1, 2004, through December 31,
2015.
Results : A total of 144 patients were studied (87 survived, 11 lost to
follow up, 46 died). Patients with bilateral CMVR and six-
month follow up CD4 + T cell count < 50 cells/mm3 have
shorter time to mortality, compared to patients with CD4 + T
cell count > 50 cells/mm3 (p < .001) and unilateral disease
(p = .043). Baseline CD4 + T cell count, size and zone of
initial primary retinitis lesions, recurrences of retinitis, and
timing of combined antiretroviral therapy (cART) are not
significantly associated with mortality.
Conclusion : Bilateral ocular involvement and lack of immune recovery in
patients with AIDS and CMVR are associated with shorter
survival time.
Summary and : This study described the epidemiology and clinical features
learning outcomes of AIDS patients with CMVR in a multi-ethnic population.
Bilateral CMVR and the lack of immune recovery despite
cART (final CD4 + T cells count <50 cells/mm3) are likely
risk factors for mortality. CD4 + T cell count at diagnosis,
clinical features of CMV retinitis lesion at baseline, and
CMVR recurrence are not associated with mortality. Further
studies may prospectively evaluate the correlation between
the clinical severity of CMVR, initial CD4 + T cell count and
compliance to treatment. That will require collaboration with
the physicians in charge of the patients for a more
comprehensive analysis involving accurate and objective
data on cART. This information also may be used for patient
counseling to encourage compliance with treatment.