CLINICAL CHARACTERISTICS OF CYTOMEGALOVIRUS RETINITIS IN HUMAN IMMUNODEFICIENCY VIRUS (HIV) PATIENTS UNDERGOING INTRAVITREAL GANCICLOVIR INJECTION
Article Sidebar
Main Article Content
Abstract
Introduction: Cytomegalovirus (CMV) retinitis is the most common ocular opportunistic infection in patients with Human immunodeficiency virus (HIV). The disease is causing blindness and current management commonly characterized by delayed diagnosis and inadequate treatment.
Purpose: to describe the clinical characteristic and visual outcome of CMV retinitis with HIV treated with intravitreal ganciclovir injection.
Methods: This is a retrospective study included 23 patients (34 eyes) who presented with CMV Retinitis with HIV from January 2020 to July 2023 who received intravitreal ganciclovir in both the induction and maintenance phases until declared cured, characterized by lesion inactivation and CD4+ T-cell counts reaching >100/µL within period of 3 to 6 months. Data were collected including age, gender, affected eye laterality, CD4+ T-cell count at the initial visit at vitreoretinal polyclinic and the 6-month follow-up, total number of intravitreal ganciclovir injections, HAART history at the initial visit, visual acuity at the initial visit, 6-month follow-up, and systemic comorbidities.
Result: The median age was 29 years old with 82,6% of them male. Bilateral lesions were observed in 60.9% of the patients. Median CD4 count initial visit was 50 with 52% below 50 cell/µL. Fifteen patients (65,2%) already treated with highly active antiretroviral therapy (HAART) before injection. Tuberculosis was the most common opportunistic infection. Mean intraviteral ganciclovir injection 9,12±3,40 in each eye. Eleven eyes (32.4%) with initial visual acuity ≤1.00 logMAR increased to 19 eyes (55.9%) at the 6-month follow-up. There were statistically significant difference between baseline visual acuity and 6-months follow up after intravitreal ganciclovir. (p= 0,008).
Conclusion: Retinitis cytomegalovirus tend to have more severe clinical presentations in patients with CD4 counts below 50 cells/µL. Intravitreal ganciclovir is effective in controlling CMV retinitis.
Keywords
cytomegalovirus retinitis; HIV;GAnciclovir
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
2. Doan S, Cochereau I, Hoang-Xuan T. Cytomegalovirus retinitis in HIV-infected patients with and without highly active antiretroviral therapy. American Journal of Ophthalmology.1999;128(2):250-251.
3. Naryati,L.P.E., Susila, N.K.N., Juliari, I.G.A.M., Manuaba, I.B.P., Triningrat, A.A.M.P.2017. Karakteristik retinitis cytomegalovirus pada pasien human immunodeficiency virus(HIV) di rsup sanglah denpasar tahun 2012-2015. Medicina 48(3): 195-200.
4. Epidemiological fact sheet – HIV statistics, globally and by WHO region,global-hiv-hepatitis and stis programmes/hiv/strategic-information/ hiv data and statistics. July 2023
5. Ei WLSS, Pyar Soe K, Hilbig A, Murray J, Heiden D, editors. Routine immediate eye examination at the point of care for diagnosis of AIDS-related cytomegalovirus retinitis among patients with a CD4 count< 100 in Myanmar. Open forum infectious diseases; 2019: Oxford University Press US.
6. Sovani I, Feby A. Clinical Characteristics and Management of Cytomegalovirus Retinitis with HIV in Cicendo Eye Hospital National Eye Center, Bandung. 2018;1:2
7. Munro M, Yadavalli T, Fonteh C, Arfeen S, Chan, A.M.L., Microorganism.2020 Jan;8(1):55.
8. Port AD, Orlin A, Kiss S, Patel S, D’Amico DJ, Gupta MP. Cytomegalovirus Retinitis: A Review; 2017. Journal Of Ocular Pharmacology and Therapeutics 33:4
9. Nkomazana O, Tshitswana D. Ocular complications of HIV infection in Sub-Sahara Africa. Curr HIV. AIDS Rep. 2008 (5): 120-125.
10. Singh SR, Dogra M, Kaur S, Bajgai P, Tigari B, Handa S, et al. Spectrum of newly diagnosed cytomegalovirus retinitis in a developing country in the HAART era. 2018
11. Leenasirimakul P, Liu Y, Jirawison C, Khienprasit N, Kamphaengkham S, Ausayakhun S, et al. Risk factors for CMV retinitis among individuals with HIV and low CD4 count in northern Thailand: importance of access to healthcare. 2016;100(8):1017-1021.
12. Xaverina YR, Sofia O. Clinical Manifestations and CD4 Count Characteristics of Patients With Cytomegalovirus (CMV) retinitis. International Journal of Retina 2022. vol 5 (2).
13. Ali M, Razok A, Gassim M, Elmaki N, Goravey W, Alkhal A, Almaslamani M, Alsoub H. HIV and AIDS Defining Opportunistic in The State of Qatar : A Cohort Population Based Retrospective Study Covering 17 years (200-2016); 2022. Annals of Medicine and Surgery 78:103842
14. Orlin A, Nadelmann J, Gupta M. Cytomegalovirus Retinitis Outcome in HIV-Infected and Non-HIV Patients at a Tertiary Care Center. Journal of VitreoRetinal Diseases. 2017;1 (1):57-64
15. Iu LP, Fan MC, Lau JK, Chan TS, Kwong Y-L, Wong IYJAJoO. Long Term Follow up of Cytomegalovirus Retinitis in Non-HIV. Immunocompromised Patients: Clinical Features and Visual Prognosis. 2016;165:145-53
16. Sugar E.A., Jabs D.A., Ahuja A., Thorne J., Danis R.P., Meinert C.L. Incidence of Cytomegalovirus Retinitis in the Era of Highly Active Antiretroviral Therapy. Am J ophtalmol. 2021; 153(6): 1016-1024.
17. Agarwal A, Kumari N, Trehan A, Khadwal A, Dogra MR, Gupta V, Sharma A, Gupta A, Singh R. Outcome of Cytomegalovirus retinitis in Immunocompromised Patients without Human Immunodeficiency Virus Treated with Intravitreal Ganciclovir Injection; 2014: Graefes Arch Clin Exp Ophthalmol 252:1393-1401.
18. Kemenkes RJKKR, Jakarta. infoDATIN, Pusat Data dan Informasi Kementrian Kesehatan RI, HIV AIDS 2022.2022/
19. He XQ, Huang YQ, Zeng YM, Qin YY, Tang SQ, Xu XL, Harypursat V, Lu YQ, Liu M, Chen YK. Timing of antiretroviral Theraphy for HIV-Infected Patients with Cytomegalovirus Retinitis: Study Protocol of a Multi-Center Prospective Randomized Controlled Trial; 2021: BMC Journal 22:218.-+
20. Jabs, DA et al. Long Term Outcomes of Cytomegalovirus Retinitis in the Era of Modern Antiretroviral Theraphy: Results from a United States Cohort; 2015. Ophthalmology 122:1452-1463
21. Xie LY, Chen C, Kong WJ, Du KF, Guo CG, Dong HW, Wei WB. Effect of Individualized Theraphy for AIDS Patients with Cytomegalovirus Retinitis in Intravitreal Ganciclovir Injections. Int J Ophthalmol 2019 Vol 12(8)
22. Sudharshan S, Babu RB, Nair N, Biswas J. Combined Infection of Ocular Tuberculoma and Cytomegalovirus Retinitis in the Same Eye of a Patient with Human Immunodeficiency Virus. Indian J Ophthalmol 2020; 68(9): 1965-1967
23. Choopong P, Vivittaworn K, Konlakij D, Thoongsuwan S, Pituksung A, Tesavibul N. Treatment Outcomes of Reduced Dose Intravitreal Ganciclovir For Cytomegalovirus. BMC Infectious Diseases. 2016;16:164
24. Stewart MW,. Optimal Management of Cytomegalovirus Retinitis in Patients With AIDS. Clinical Ophthalmology. 2010;4:285-99