Recovery of long-term natural protection against reactivation of CMV retinitis in AIDS patients responding to highly active antiretroviral therapy

• Published in: The Journal of infection Vol. 39; no. 3; pp. 193 - 197
• Main Authors: Di Perri, Giovanni, Vento, Sandro, Mazzi, Romualdo, Bonora, Stefano, Bonora, Adriana, Trevenzoli, Marco, Allegranzi, Benedetta, Carretta, Giovanni, Lanzafame, Massimiliano, Pizzighella, Sergio, Concia, Ercole
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.11.1999; Elsevier
• Subjects: Acquired Immunodeficiency Syndrome - drug therapy; Acquired Immunodeficiency Syndrome - immunology; Adult; AIDS-Related Opportunistic Infections - drug therapy; AIDS/HIV; Anti-HIV Agents - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antigens, Viral - blood; Antiviral agents; Antiviral Agents - therapeutic use; Biological and medical sciences; CD4 antigen; CD4 Lymphocyte Count; Cytomegalovirus; Cytomegalovirus Retinitis - drug therapy; Female; highly active antiretroviral therapy; Human immunodeficiency virus; Humans; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; RNA, Viral - blood; Human; Immunopathology; Opportunistic infection; Chemoprophylaxis; Reactivation; Relapse; Retinopathy; Herpesviridae; AIDS; Betaherpesvirinae; Immune deficiency; Human cytomegalovirus; Infection; Virus; Prevention; Eye disease; Chemotherapy; Treatment; Treatment withdrawal; Maintenance treatment; Viral disease; Antiviral; Complication; Retinitis
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/S0163-4453(99)90048-8

Objectives: To see whether in severely immunosuppressed AIDS patients (with prior Cytomegalovirus retinal disease) who have significant increases in CD4+ lymphocytes following the initiation of highly active antiretroviral therapy (HAART) anti-Cytomegalovirus (CMV) maintenance therapy can be withdrawn with no subsequent progression of CMV retinitis. Methods: Eight patients with AIDS and one or more previous episodes of CMV retinitis interrupted anti-CMV maintenance therapy following the successful beginning of HAART. CD4 cell counts and HIV-RNA were monitored monthly while measurement of CMV antigenemia and ophthalmoscopy were carried every 2 weeks thereafter. Results: The HAART recipients in whom anti-CMV maintenance therapy had been interrupted had measureable increases of CD4+ T lymphocytes, substantial control of both HIV-RNA and CMV viraemia and did not show recurrence of retinitis during a mean follow-up of 98.4 weeks (range 78–120, SD 15.2). Conclusions: Anti-CMV maintenance therapy can be interrupted with no subsequent progression of retinal damage over a long time in patients with AIDS who successfully respond to HAART with a significant increase in CD4 cell count.