UNIVERSITY OF EXPERIMENTAL TECHNOLOGY AND INVESTIGATION YACHAY

TECH
SCHOOL OF BIOLOGY AND ENGINEERING

CMV Retinitis

Authors: Andrés Mina, Truman Tapia, Bryan Vargas, Andrea Albán, Esteban Guamba
 What is CMV Retinitis?

● An opportunist ocular disease that

destroys the retina producing a
permanent blindness. [1]
● It is produced by the infection of the
cytomegalovirus. [1]
● People who have a weak immunologic
system. [1]

[1] Stewart M. (2010), Optimal management of cytomegalovirus retinitis in patients with AiDS, Pgs. 285-291.
 ● This disease was known in 1981. [2]
● The principal causes of blindness in
patients with AIDS. [1]
● The CMV retinitis occurred in one-third of
patients with AIDS, and over 90% of cases
of HIV-related blindness. [3]

[1] Stewart M. (2010), Optimal management of cytomegalovirus retinitis in patients with AiDS, Pgs. 285-291.
[2] Vejerano A. (2016), Cytomegalovirus retinitis in a HIV patient , Pgs.741-745.
[3] Heiden D. (2007), Cytomegalovirus Retinitis: The Neglected Disease of the AIDS Pandemic , Vol.4, Pgs.1846-1850.
 Which are the symptoms?
Some of the symptoms that people with CMV retinitis can present are:[2]

● blurred vision
● photophobia
● photopsia.
● nyctalopia,
● Difficulty of reading.
● Scotoma,

[2] Vejerano A. (2016), Cytomegalovirus retinitis in a HIV patient , Pgs.741-745.

 What happen inside the eye?
● The main affections are in macula, the optic nerve and the vessels. [3]
● The CMV produces the retinal necrosis, superficial hemorrhages and injuries.[3]

[3] Heiden D. (2007), Cytomegalovirus Retinitis: The Neglected Disease of the AIDS Pandemic , Vol.4, Pgs.1846-1850.
 Importance of diagnosis
There are two ways for the detection of CMV retinitis:[3]

1. lymphocyte tale. 2. The “gold standard”

The correct diagnosis is important because AIDS people can begin early a treatment
and have a good lifestyle.[2]

[2] Vejerano A. (2016), Cytomegalovirus retinitis in a HIV patient , Pgs.741-745.

[3] Heiden D. (2007), Cytomegalovirus Retinitis: The Neglected Disease of the AIDS Pandemic , Vol.4, Pgs.1846-1850.
NUMBERS AND
DATA
Numbers
Numbers
Although a large percentage of the human population is infected with the virus, only
those with significant compromise of the immune system develop retinitis.
Numbers
● During the height of the AIDS epidemic, nearly 30 percent of AIDS patients
developed CMV retinitis.
Numbers

● Number of people with AIDS from South Africa : 7 100 000

If we take the 30%

It means that nearly 2 000 000 people developed CMV retinitis.

CMV Retinitis in Ecuador.

Sorround 5000 AIDS cases in

Ecuador 2 years ago, it
means two years ago there
was at least 1500 people
with CMV retinitis.
TREATMENTS
Glanciclovir

Leonard S. Kirsch, J. Fernando Arevalo, Eugenio Chavez de la Paz, David Munguia, Erik de Clerq, William R. Freeman,
Intravitreal Cidofovir (HPMPC) Treatment of Cytomegalovirus Retinitis in Patients with Acquired Immune Deficiency Syndrome,Ophthalmology,Volume 102,Issue
4,1995,Pages 533-543,ISSN 0161-6420,https://doi.org/10.1016/S0161-6420(95)30985-2.
Most of patients developed Uveities.
High Activity Antiretroviral Therapy (HAART)

Most used in
patients with
HIV SIDA.
This process generates several
mutations, mutations that cause
resistance to medicamentsx.
Leonard S. Kirsch, J. Fernando Arevalo, Eugenio Chavez de la Paz, David Munguia, Erik de Clerq, William R. Freeman,
Intravitreal Cidofovir (HPMPC) Treatment of Cytomegalovirus Retinitis in Patients with Acquired Immune Deficiency Syndrome,Ophthalmology,Volume
102,Issue 4,1995,Pages 533-543,ISSN 0161-6420,https://doi.org/10.1016/S0161-6420(95)30985-2.
 Propose Treatment

Combining two treatments:

● Biodegradable scleral implant releasing cidofovir.

● HAART (in HIV patients) or valganciclovir (non HIV patients).

 Scleral implant releasing cidofovir [6]

● The implant could be made of mixtures of poly(DL-lactide) and cidofovir.

● Small sizes have been reached.
● The device is implanted with sclerotomy in the supratemporal quadrant of the eye.
● The device keeps constant the presence of cidofovir in the retina.
● Long duration of the implant.
● The implant disappears after the time of use, which avoids making removal surgery.

[6] Yasukawa, T., Kimura, H., Kunou, N., Miyamoto, H., Honda, Y., Ogura, Y., & Ikada, Y. (2000). Biodegradable scleral implant for intravitreal
controlled release of ganciclovir. Graefe's archive for clinical and experimental ophthalmology, 238(2), 186-190.
Scleral implant releasing cidofovir

Parts of the eye Quadrants of the eye

Scleral implant releasing cidofovir

implant
HAART/VALGANCICLOVIR?

● If the patient has HIV or immunodeficient (the most common situation), we propose to combine

the implant with the usual HAART treatment.

● If the patient is not affected with HIV or immunodeficient, we propose to combine the implant

with valganciclovir (900 mg twice daily for two weeks).

Why this treatment?

● Cidofovir (10 times active effective, 200

more active than forscarnet )[7]
● Six months of use
● Biodegradable
● No body propagation due to HAART or
valganciclovir
[6] Yasukawa, T., Kimura, H., Kunou, N. et al. Graefe's Arch Clin Exp Ophthalmol (2000) 238: 186. https://doi.org/10.1007/s004170050031
Leonard S. Kirsch, J. Fernando Arevalo, Eugenio Chavez de la Paz, David Munguia, Erik de Clerq, William R. Freeman,
[7] Intravitreal Cidofovir (HPMPC) Treatment of Cytomegalovirus Retinitis in Patients with Acquired Immune Deficiency Syndrome,Ophthalmology,Volume 102,Issue
4,1995,Pages 533-543,ISSN 0161-6420,https://doi.org/10.1016/S0161-6420(95)30985-2.
Conclusions:
● The CMV Retinitis is an ocular disease that destroys
the retina produced by the Cytomegalovirus in people
with a weak immunologic system.
● the alternative of scleral implant that release a
controlled dosis of cidofovir will present many
advantages in the battle against CMV retinitis.
● There is important to develop more effective
protocols to early discovery and treatment of CMV
Retinitis liked to HIV in developing countries.
References:
[1] Stewart M. (2010), Optimal management of cytomegalovirus retinitis in patients with AiDS, Pgs. 285-291.
[2] Vejerano A. (2016), Cytomegalovirus retinitis in a HIV patient , Pgs.741-745.
[3] Heiden D. (2007), Cytomegalovirus Retinitis: The Neglected Disease of the AIDS Pandemic , Vol.4, Pgs.1846-1850
[4] Guevara C. (2017), Informe GAM Ecuador, monitoreo global del sida, Pgs. 11-12.
[5] Bonfanti P. Capetti A. Rizzardine G. (1999). HIV disease treatment in the era of HAART. Pgs. 97-98-99-100.
[6] Yasukawa, T., Kimura, H., Kunou, N., Miyamoto, H., Honda, Y., Ogura, Y., & Ikada, Y. (2000). Biodegradable scleral
implant for intravitreal controlled release of ganciclovir. Graefe's archive for clinical and experimental ophthalmology,
238(2), 186-190.
[7] Intravitreal Cidofovir (HPMPC) Treatment of Cytomegalovirus Retinitis in Patients with Acquired Immune
Deficiency Syndrome,Ophthalmology,Volume 102,Issue 4,1995,Pages 533-543,ISSN
0161-6420,https://doi.org/10.1016/S0161-6420(95)30985-2.