CMV retinitis recurs after stopping treatment in virological and immunological failures of potent antiretroviral therapy

AIDS. 2000 Jan 28;14(2):173-80. doi: 10.1097/00002030-200001280-00013.


Objectives: To determine predictors of clinical relapse of cytomegalovirus (CMV) end-organ disease in a cohort of 17 HIV-infected patients with healed and treated CMV retinitis (CMVR) who responded to HAART with an increase in CD4 cell counts to above 70 cells/mm3 and discontinued CMV maintenance therapy (MT).

Design: Seventeen patients were monitored for reactivation of retinitis. The CD4 cell counts, HIV RNA and peripheral blood mononuclear cell (PBMC) lymphoproliferative assays to CMV at 3 month intervals were compared between patients with and without reactivation of CMVR. Positive lymphoproliferative responses were defined as a stimulation index of 3 or greater.

Results: Five out of 17 (29%) patients experienced a recurrence of CMVR a mean of 14.5 months after stopping CMV MT and between 8 days and 10 months after CD4 cell counts fell below 50 cells/mm3. Median CD4 cell counts and plasma HIV RNA at reactivation were 37 cells/mm3 and 5.3 log10 copies/ml. Three patients recurred at a previously active site of the retina, one had contralateral CMVR, and one a recurrence of retinitis and pancreatitis simultaneously. Mean lymphoproliferative responses to CMV were 2.4 in patients with reactivation versus 21.0 stimulation index (SI) in patients without reactivation (P= 0.01). A model incorporating four variables (CD4 cell counts and HIV RNA at maintenance discontinuation, highest CD4 cell count, nadir HIV RNA and median lymphoproliferative responses) identified correctly 88% of patients with and without reactivation.

Conclusion: CMV disease recurs after virological and immunological failure of HAART if CD4 cell counts drop below 50. In this situation, anti-CMV agents should be resumed before clinical reactivation ensues, because of the risk of contralateral retinal involvement and systemic disease.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy*
  • AIDS-Related Opportunistic Infections / immunology
  • AIDS-Related Opportunistic Infections / virology
  • Adult
  • Anti-HIV Agents / therapeutic use*
  • CD4 Lymphocyte Count / drug effects
  • Cohort Studies
  • Cytomegalovirus / drug effects
  • Cytomegalovirus Retinitis / drug therapy*
  • Cytomegalovirus Retinitis / prevention & control
  • Female
  • HIV* / drug effects
  • HIV* / genetics
  • Humans
  • Lymphocyte Activation
  • Male
  • Middle Aged
  • Prospective Studies
  • RNA, Viral / blood
  • Recurrence
  • Risk Factors
  • T-Lymphocytes / immunology
  • Treatment Failure
  • Viral Load


  • Anti-HIV Agents
  • RNA, Viral