Visual acuity outcomes in cytomegalovirus retinitis: early versus late diagnosis.

Aims: To determine if early dilated fundus examination for cytomegalovirus (CMV) retinitis leads to better visual outcomes in areas with limited HIV care, where patients may have long-standing retinitis before they are diagnosed with HIV.
Methods: Twenty-four eyes of 17 patients with CMV retinitis who were seen at an urban HIV clinic in Chiang Mai, Thailand, were included in this retrospective cohort study. Participants were divided into two groups based on the amount of time from the first documented CD4 count below 100 cells/mm ³ to the first eye examination for CMV retinitis. Average visual acuity in each group was calculated at the time CMV retinitis was first detected, and then at 3, 6 and 12 months after diagnosis.
Results: The group of patients who received an eye examination within approximately 4 months of the initial low CD4 count measurement had better baseline visual acuity (median 20/30,IQR 20/20 to 20/60) compared with patients who presented later (median 20/80, 20/60 to hand motion); p=0.03). Visual acuity did not change significantly during the 12-month study period in either the early group (p=0.69) or late group (p=0.17).
Conclusion: In this study, patients who were examined sooner after a low CD4 count had better vision than patients who were examined later. Routine early screening of patients with CD4 counts under below 100 cells/mm ³ may detect earlier disease and prevent vision loss.
Competing Interests: Competing interests: GNH has served on advisory boards for the following companies: Genentech (South San Francisco, CA), Novartis (Basel, Switzerland), Santen (Emeryville, CA) and Xoma (Berkeley, CA). TPM has pending intellectual property with the University of California (Berkeley, CA) describing a mobile phone camera for retinal imaging. At the current time this intellectual property has no financial value.
(© Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.)