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CMV still a problem? How do you prevent it?
Aug 5, 2003

Dr. Bob,

Hello from a worried Polish American who has just glanced over an article that i quite distrubing. Is this true that CMV often occurs with individuals taking HART and how can we all prevent it from occuring. Please give your reasoning.

I patiently await your reply. Stay Well.

Bart

CMV-related visual loss remains common in HAART era

Last Updated: 2003-06-30 13:28:12 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Depending on immune recovery status, visual loss related to cytomegalovirus retinitis can often occur in HIV-infected individuals treated with highly active antiretroviral therapy (HAART), according to a report in the July British Journal of Ophthalmology.

Inflammatory sequelae and visual loss have complicated healed CMV retinitis in the setting of immune recovery following HAART, the authors explain, but long-term visual outcomes have not been systematically assessed.

Dr. William Freeman from University of California San Diego in La Jolla, California, and associates determined the long-term visual outcome of 63 HAART-treated AIDS patients (90 eyes) with extramacular CMV retinitis in relation to immune failure or immune recovery with or without immune recovery uveitis (IRU).

Twenty-one of 48 patients (26 eyes) who achieved immune recovery developed IRU, the report indicates.

Patients with immune recovery but without IRU had the lowest incidence of ocular sequelae, the authors report, whereas the highest incidence occurred in patients with immune recovery and IRU.

Also, the highest rate of cataract formation (84) occurred in eyes with IRU, the results indicate, while the lowest incidence was seen in eyes without IRU in immune-recovery patients.

Similarly, moderate visual loss was most likely to develop in eyes with immune recovery and subsequent IRU, the researchers note, and severe visual loss was significantly associated with retinal detachment.

"We attribute our findings to the high incidence of intraocular inflammation secondary to HAART induced immune recovery uveitis in the setting of healed CMV retinitis," the authors conclude. "In the HAART era, vision loss is still common in CMV retinitis patients."

Br J Ophthalmol 2003;87:853-855.

Response from Dr. Frascino

Hi,

This forum is dedicated to Fatigue and Anemia, so I'll only be able to reply briefly. This report refers to HIV-positive folks who had very low CD4 cell counts and developed a smoldering CMV opportunistic infection. When they were placed on effective HAART therapy, their immune systems improved, and as a consequence, their immune systems began fighting the CMV infection. This causes additional inflammation (IRU). So don't worry, OK? Nothing really new is going on here. CMV remains a problem primarily for folks with very low CD4 counts (under 50).

Dr. Bob


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