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Risk Factors for Advancement of Cytomegalovirus Retinitis in Patients With Acquired Immunodeficiency Syndrome
Janet T. Holbrook, PhD, MPH;
Matthew D. Davis, MD;
Larry D. Hubbard, MA;
Barbara K. Martin, PhD;
Gary N. Holland, MD;
Douglas A. Jabs, MD, MS;
Adele Kaplan Gilpin, PhD, JD;
Curtis Meinert, PhD;
Daniel S. Reshef, MD, MPH, PhD;
for the Studies of Ocular Complications of AIDS Research Group
Arch Ophthalmol. 2000;118:1196-1204.
Objective To identify ocular and systemic factors that predict advancement of cytomegalovirus (CMV) retinitis during treatment.
Methods Patients with acquired immunodeficiency syndrome were enrolled in a multicenter clinical trial designed to evaluate foscarnet sodium and ganciclovir sodium as therapy for newly diagnosed CMV retinitis. Ocular characteristics at baseline and measurements of retinitis were assessed from fundus photographs by graders at a fundus photograph reading center. The following measures of advancement were assessed: (1) lesion border movement of at least 750 µm or development of a new lesion in involved eyes; (2) rate of increase in retinal area with CMV in involved eyes; and (3) development of retinitis in uninvolved eyes of patients with unilateral disease at baseline.
Results In eyes with retinitis, risk factors at baseline for advancement while receiving treatment included smaller area involved, active margins of retinitis, and posterior location. Risk factors for development of retinitis in uninvolved fellow eyes included blood and urine cultures positive for CMV and lower CD8+ T-lymphocyte count.
Conclusions Lesion characteristics can be used to predict advancement of preexisting disease, whereas only systemic factors are associated with development of bilateral disease. These analyses describe retinitis activity before the introduction of potent antiretroviral therapies but provide an important reference point for patients in whom CMV retinitis develops after failure or intolerance of antiretroviral agents.
From the Center for Clincal Trials, Department of Epidemiology (Drs Holbrook, Martin, Gilpin, Meinert, and Reshef), and the Departments of Ophthalmology and Medicine (Dr Jabs), The Johns Hopkins University School of Medicine, Baltimore, Md; the Fundus Photograph Reading Center, University of Wisconsin, Madison (Dr Davis and Mr Hubbard); and the University of California–Los Angeles Ocular Inflammatory Disease Center, Jules Stein Institute and Department of Ophthalmology, University of California–Los Angeles School of Medicine (Dr Holland). A complete list of participants in the Studies of Ocular Complications of AIDS was published previously (Arch Ophthalmol. 1996;114:804).
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