The safety of discontinuation of maintenance therapy for cytomegalovirus (CMV) retinitis and incidence of immune recovery uveitis following potent antiretroviral therapy.

Abstract

BACKGROUND:

Reconstitution of immune function during potent antiretroviral therapy can prompt discontinuation of maintenance cytomegalovirus (CMV) therapy but has also been associated with sight-threatening inflammatory conditions including immune recovery uveitis (IRU).

METHOD:

Patients with inactive CMV retinitis and a CD4+ cell count above 100/mm3, receiving CMV therapy and stable combination antiretroviral therapy, were assigned to one of two groups based on willingness to discontinue CMV therapy.

RESULTS:

Thirty-eight participants were enrolled: 28 discontinued anti-CMV therapy (Group 1) and 10 continued CMV treatment (Group 2). Median on-study follow-up was 16 months. One Group 1 participant who experienced an increase in plasma HIV viral load and a decline in CD4+ cell count developed confirmed progression of CMV retinitis. Progression or reactivation CMV retinitis was not observed among Group 2. IRU was present at study entry in 3 participants. Six participants in Group 1 and 3 participants in Group 2 developed IRU on-study. CMV viremia was not detected in any participants, and urinary shedding of CMV was intermittent.

CONCLUSION:

Recurrence of CMV retinitis following discontinuation of anti-CMV therapy among patients with antiretroviral-induced increases in CD4+ cell count was rare. However, IRU was common in both those who maintained and discontinued anti-CMV therapy.

• Authors: D A Wohl, M A Kendall, S Owens, G Holland, M Nokta, S A Spector, R Schrier, S Fiscus, M Davis, M A Jacobson, J S Currier, K Squires, B Alston-Smith, J Andersen, W R Freeman, M Higgins, F J Torriani, ACTG 379 Study Team
• Journal: HIV clinical trials (HIV Clin Trials) 2005 May-Jun Vol. 6 Issue 3 Pg. 136-46 ISSN: 1528-4336 [Print] England
• PMID: 16192248 (Publication Type: Clinical Trial, Journal Article, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Antiviral Agents
• RNA, Viral

Topics

• Adult
• Antiviral Agents (therapeutic use)
• CD4 Lymphocyte Count
• Cytomegalovirus (immunology)
• Cytomegalovirus Retinitis (complications, drug therapy, immunology, virology)
• Female
• HIV Infections (complications, drug therapy, immunology, virology)
• HIV-1 (immunology)
• Humans
• Male
• Middle Aged
• Prospective Studies
• RNA, Viral (blood)
• Recurrence
• Substance Withdrawal Syndrome (immunology)
• Uveitis (complications, immunology, virology)