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Case Report: An HIV infected patient with cytomegalovirus retinitis with a CD4 lymphocyte count of 498 cells/mm3 after a good response to highly active antiretroviral therapy is described., Comment: Some aspects of the immune system after highly active antiretroviral therapy remain unknown. CD4 T lymphocyte count might not be a good marker to identify some patients at risk of developing cytomegalovirus retinitis after this therapy.

Purpose: A study of protease inhibitors on CMV retinitis in HIV infected hospital patients., Method: A retrospective study was performed in 485 diagnosed of AIDS, between January, 1990 and December 1998. Among those, 81 patients who were diagnosed of CMV retinitis, the following was studied: anti-retroviral treatment, anti CMV treatment, survival time and CD4 lymphocyte count., Results: Treatment with protease inhibitors in HIV patients showed an increase in life expectancy, reduced the incidence of CMV retinitis and a reduction in CMV retinitis prevention treatment was observed., Conclusions: Treatment with protease inhibitors has reduced the rate of CMV retinitis in HIV patients.

Purpose: To describe the ocular changes observed in six patients treated with intravenous cidofovir for cytomegalovirus retinitis., Methods: We have studied six patients (12 eyes) treated with intravenous cidofovir. A complete ophthalmologic examination was performed before and after each dose during the follow-up period, paying special attention to intraocular pressure changes., Results: Three cases of non-granulomatous anterior uveitis with good response to conventional treatment were detected. The intraocular pressure decreased after the administration of the two first doses of the drug (p<0.01), and was followed by stabilization of the intraocular pressure with the next doses. In two of the eyes (16.7%), the decrease in the intraocular pressure was more than 50% in comparison to the measurements at the onset of treatment. In three eyes (18.7%), we detected acute anterior uveitis, which responded well to conventional treatment., Conclusions: The intravenous administration of cidofovir for the treatment of cytomegalovirus retinitis is associated with important ocular changes that must be carefully observed in the follow-up of these patients.

During the last two years important advances in the diagnosis and treatment of cytomegalovirus (CMV) disease have occurred. Several studies have suggested that biologic markers of CMV viremia (PCR, branched DNA and pp65 antigenemia) might be useful both to stratify the risk of developing CMV disease and to follow the response of CMV retinitis to therapy. It has been shown that patients who are plasma CMV PCR positive have a risk of developing CMV disease three times higher than patients who are plasma CMV PCR negative. In addition, for each log10 increase of the CMV viral load there is a 3-fold higher risk of developing CMV disease. Currently, therapeutic options for induction treatment of CMV retinitis (CMVR) are: i.v. ganciclovir (GCV), i.v. foscarnet, i.v. cidofovir or GCV intraocular implant combined with oral GCV. For maintenance therapy options are: i.v. GCV (3, 5 or 7 days per week), oral GCV (only for peripheral retinitis), i.v. foscarnet (daily), i.v. cidofovir (biweekly) and GCV intraocular implant (replaced every 6-8 months) combined with oral GCV. There is currently enough evidence to allow the diagnosis of progressive multifocal leukoencephalopathy (PML) based on the finding of JC virus DNA in CSF by PCR. There are still no drugs with proven clinical efficacy against JC virus but the possibility that HAART treatments might improve the control of this disease appear promising.

Background: An approach of daily or 5 days per week treatment as maintenance therapy is mandatory among HIV patients with CMV retinitis. We evaluate the efficacy and tolerance of thrice weekly maintenance therapy for CMV retinitis in AIDS patients., Methods: Sixty nine consecutive patients with CMV disease were eligible for a prospective open clinical trial. Thirty three completed the induction treatment of CMV retinitis, agreed on maintenance thrice weekly and were included. Twenty nine received Ganciclovir (10 mg/kg/day) and 4 foscarnet (100 mg/kg/day) thrice weekly., Results: The mean age was 34 years. Twenty nine of the 33 (87%) were males and 13 (39%) drug addicts. Mean CD4+ lymphocyte count at inclusion was 44 cells per relapsed and 22 (66%) died. The median time to relapse, survival free of CMV retinitis and the median survival was 18, 14 and 34 weeks respectively., Conclusion: Since the outcome of our patients with thrice weekly maintenance therapy was similar to historical controls our study at least provides the rational for this hypothesis to be tested in a future randomised trial.

Background: In this paper we study the digestive manifestations of cytomegalovirus (CMV) in AIDS patients. Also, we evaluate the antiviral treatment and the necessity of maintenance therapy., Methods: Retrospective review of medical charts of all patients with AIDS and digestive CMV disease diagnosed and followed-up since 1983 to december 1993., Results: Of 720 AIDS patients, 96 presented a CMV disease. Among them, 30 patients (31%) complained digestive manifestations. These were 26 males and 4 females, mean age: 37.4 y-old. Risk factors for HIV were: 13 homosex and 12 intravenous drug abusers. Average of time between AIDS diagnosis and digestive CMV disease: 13.4 months. Fourteen patients had esophagitis, 9 proctocolitis, 3 hepatitis, 3 pancreatitis, 2 gastric ulcerations, one small bowel disease and other an oral ulceration. Two patients had a concomitant CMV chorioretinitis. CD4 lymphocytes were below 0.05 x 10(9)/l in 29 patients. Twenty-four patients received antiviral treatment during the acute disease period, with a clinical curation rate of 60%. Seven patients received maintenance therapy and remained free of CMV disease until death. Eleven patients didn't received maintenance treatment. Of them, one patient presented a digestive relapse and two developed a CMV chorioretinitis. Mortality in the first month from diagnosis was 23% and the median of survival time for patients who cured and initial episode of digestive CMV disease was 208 days, wether or not the patient received maintenance therapy or not., Conclusions: One third of ours patients with AIDS and CMV infection have a digestive disease. This CMV digestive disease appears in patients with a severe immunosuppression. Acute phase mortality was 23%. The median survival was 7 months, independently or receiving maintenance treatment or not.

An HIV-infected woman with a CD4+ T-cell count below 100 x 10(6)/l survived for longer than 4 years of being diagnosed of AIDS, with acceptable health status (Karnofsky > 80%). Administration of foscarnet during two years, recommended as suppressive therapy for a previous cytomegalovirus retinitis, might have caused a sustained reduction in plasma HIV-RNA, contributing to her long-term survival.

A retrospective study was made of 26 patients with AIDS who initially presented with retinitis as the only clinical manifestation of cytomegalovirus infection (39 eyes). Sixty-five induction or re-induction therapeutic courses were administered with intravitreal ganciclovir. The efficiency rate of therapy was 93.8%. Thirty-eight maintenance therapeutic courses (200 micrograms/week) were evaluated. The non-compliance rate was 23%. Bilateral retinitis occurred in 44.4% of cases. The systemic administration of therapy had to be substituted for the intravitreal administration in 32% of patients during the clinical course of their conditions. The mean survival rate was 9.5 months. Both retinal detachment and vitreal hemorrhage occurred in 5% of patients. When retinitis is the first clinical manifestation of cytomegalovirus infection, therapy with intravitreal ganciclovir is efficacious to inactivate lesions. Although bilateral retinitis and extraocular dissemination are common, the mean survival rate is high.