Regression of cytomegalovirus retinitis associated with protease-inhibitor treatment in patients with AIDS

Am J Ophthalmol. 1997 Aug;124(2):199-205. doi: 10.1016/s0002-9394(14)70784-6.


Purpose: To report the observation that anti-retroviral therapy that includes a protease inhibitor can induce the regression of cytomegalovirus retinitis without requiring specific anticytomegalovirus drug therapy.

Methods: We examined the fundi of four patients with advanced acquired immunodeficiency syndrome (AIDS) who were placed on highly active antiretroviral therapy consisting of two nucleoside analogs and a protease inhibitor. The combined medications resulted in increased CD4+ T-lymphocyte counts and decreased load of human immunodeficiency virus (HIV-1). A prospective evaluation of the effect of these medications on an active cytomegalovirus retinitis lesion was conducted in one patient. Retinal lesions were documented with fundus photography.

Results: None of these patients received specific anticytomegalovirus medications. The average baseline CD4+ T-lymphocyte count was 33 cells per microliter (range, 4 to 88 cells per microliter) and increased an average of 118.5 cells per microliter (range, 66 to 185 cells per microliter). Average baseline plasma HIV-1 viral loads (HIV-1-RNA copies per ml) decreased 1.46 log units (range, 0.65 to 2.93 log units). In one patient, posterior progression (border advancement toward the posterior pole) of a cytomegalovirus retinitis lesion decelerated over time and stopped. Three other patients on initial examination had areas of retinal scarring consistent with healed cytomegalovirus retinitis.

Conclusions: The addition of an HIV-1 protease inhibitor in the treatment of AIDS may lead to complete regression of cytomegalovirus retinitis without specific anticytomegalovirus medications. This effect may be related to reduced HIV-1 loads, a possible direct drug effect, an increase in CD4+ T-lymphocyte counts, or other associated changes in immune status.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / complications*
  • Acquired Immunodeficiency Syndrome / virology
  • Adult
  • Antiviral Agents / therapeutic use
  • CD4 Lymphocyte Count / drug effects
  • Cicatrix / etiology
  • Cytomegalovirus Infections / complications*
  • Cytomegalovirus Infections / drug therapy*
  • Fundus Oculi
  • HIV-1 / isolation & purification
  • Humans
  • Male
  • Middle Aged
  • Ophthalmoscopy
  • Prospective Studies
  • Protease Inhibitors / therapeutic use*
  • Retinitis / pathology
  • Retinitis / virology*


  • Antiviral Agents
  • Protease Inhibitors