Incidence and risk factors for developing cytomegalovirus retinitis in HIV-infected patients receiving protease inhibitor therapy

被引:43
作者
Casado, JL
Arrizabalaga, J
Montes, M
Martí-Belda, P
Tural, C
Pinilla, J
Gutierrez, C
Portu, J
Schuurman, R
Aguirrebengoa, K
机构
[1] Hosp Ramon & Cajal, Infect Dis Unit, E-28034 Madrid, Spain
[2] Hosp Ntra Sra Aranzazu, Infect Dis Unit, San Sebastian, Spain
[3] Hosp Badalona Germans Trias & Pujol, Badalona, Spain
[4] Hosp San Millan, Logrono, Spain
[5] Hosp Txarrigortu, Vitoria, Spain
[6] Hosp Cruces, Bilbao, Spain
[7] Univ Utrecht, Dept Virol, Utrecht, Netherlands
关键词
cytomegalovirus; retinitis; opportunistic infections; protease inhibitor; HIV;
D O I
10.1097/00002030-199908200-00009
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Objective: To assess the incidence and risk factors for cytomegalovirus (CMV) retinitis in HIV-infected patients who initiated protease inhibitor-containing antiretroviral therapy. Design and setting: Prospective, multicentre study. Patients: A cohort of 172 HIV-infected patients with a CD4 cell count below 100 x 10(6) cells/l at the time of protease inhibitor introduction. Main outcome measures: Confirmed CMV retinitis and mortality, according to CD4 cell count, HIV load, and CMV viraemia. Results: The cumulative incidence of CMV retinitis was 5% at 1 year and 6% at 2 years. Only a positive CMV polymerase chain reaction (PCR) test at therapy initiation was significantly associated with the development of disease (relative hazard, 4.41; 95% confidence interval, 2.12-8.93; P < 0.00001). The 12-month Kaplan-Meier CMV retinitis event rate was 38% in patients who were CMV PCR positive compared with 2% in those who were CMV PCR-negative (P < 0.001). Mean CMV load was significantly higher in those individuals who went on to develop CMV retinitis (3700 versus 384 copies/ml, P = 0.002). Only 2% of patients remained CMV PCR-positive after 3 months of protease inhibitor therapy, and CMV viraemia was not associated with a worse therapy response or shorter survival. Transient CMV positivity without a higher risk of disease was observed in 7% of patients at the first month on therapy. Conclusions: Protease inhibitor-containing antiretroviral therapy significantly reduces the incidence of CMV viraemia and disease. Although a positive CMV PCR test identifies those patients on therapy at highest risk of CMV retinitis, it is not associated with an increased risk of death or a worse response to protease inhibitor therapy. (C) 1999 Lippincott Williams & Wilkins.
引用
收藏
页码:1497 / 1502
页数:6
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