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von Hofsten J, Zetterberg M. Risk Factors for Cytomegalovirus Retinitis in a National Survey in Sweden. Ocul Immunol Inflamm 2024; 32:485-492. [PMID: 36625562 DOI: 10.1080/09273948.2022.2154679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/23/2022] [Accepted: 11/28/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To investigate predisposing immunosuppressive conditions causing cytomegalovirus retinitis (CMVr) and risk factors for delayed diagnosis in patients diagnosed between 2008 and 2018 in the Swedish population of 10 million. RESULTS Sixty-three consecutive patients (100 eyes) were diagnosed with CMVr. The most common immunosuppressive state predisposing for CMVr was hematopoietic stem cell transplant recipients (27%) and hematological malignancy (24%). Two patients (3.2%) had no other predisposing factor than diabetes mellitus (DM). Patients with delayed diagnosis (≤30 days) were older than those with earlier diagnosis, mean age 68.7 (±9.8) and 48.8 (±17.6), respectively, p = .001. Signs of intraocular inflammation (IOI) were seen in 42 (70%) of cases and more common in delayed than early diagnosis, 16 (89%) and 21 (60%) respectively (p = .03). CONCLUSION Delayed diagnosis was more common in older individuals with signs of IOI. DM may be a risk factor for CMVr, and clinical signs can be mistaken for diabetic retinopathy.
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Affiliation(s)
- Joanna von Hofsten
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Ophthalmology, Halland Hospital Halmstad, Halmstad, Sweden
| | - Madeleine Zetterberg
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden
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Agrawal R, Gunasekeran DV, Xu Y, Leo YS, Ng OT, Wong CS, Testi I, Ding J, Banu I, Teoh SC. Clinical Features and CD4+ T Cells Count in AIDS Patients with CMV Retinitis: Correlation with Mortality. Ocul Immunol Inflamm 2020; 30:42-47. [PMID: 32644842 DOI: 10.1080/09273948.2020.1772312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To explore the all-cause mortality in patients with acquired immune deficiency syndrome (AIDS) and Cytomegalovirus (CMV) retinitis. METHODS A retrospective cohort study of patients with CMV retinitis (CMVR) presented to a tertiary referral center in Singapore from January 1, 2004, through December 31, 2015. RESULTS A total of 144 patients were studied (87 survived, 11 lost to follow up, 46 died). Patients with bilateral CMVR and six-month follow up CD4 + T cell count < 50 cells/mm3 have shorter time to mortality, compared to patients with CD4 + T cell count > 50 cells/mm3 (p < .001) and unilateral disease (p = .043). Baseline CD4 + T cell count, size and zone of initial primary retinitis lesions, recurrences of retinitis, and timing of combined antiretroviral therapy (cART) are not significantly associated with mortality. CONCLUSION Bilateral ocular involvement and lack of immune recovery in patients with AIDS and CMVR are associated with shorter survival time.
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Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK
| | - Dinesh V Gunasekeran
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yanping Xu
- Department of Ophthalmology, Ng Teng Fong Hospital, Singapore, Singapore
| | - Yee-Sin Leo
- National Centre for Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Oon T Ng
- National Centre for Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chen Seong Wong
- National Centre for Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ilaria Testi
- Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK
| | - Jianbin Ding
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Imrana Banu
- National Centre for Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore
| | - Stephen C Teoh
- Eagle Eye Center, Gleneagles Hospital, Singapore, Singapore
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Ocieczek P, Barnacle JR, Gumulira J, Phiri S, Heller T, Grabska-Liberek I. Cytomegalovirus Retinitis Screening and Treatment in Human Immunodeficiency Virus Patients in Malawi: A Feasibility Study. Open Forum Infect Dis 2019; 6:ofz439. [PMID: 31723570 PMCID: PMC6834087 DOI: 10.1093/ofid/ofz439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background Cytomegalovirus retinitis is a treatable cause of blindness in people with human immunodeficiency virus (HIV) typically with CD4 counts <50 cells/mm3. Diagnosis is with indirect fundoscopy, and treatment is with intravitreal ganciclovir injections or systemic therapy. However, diagnosis and treatment are not widely available in Malawi, which has an adult HIV prevalence estimated at 10.6%. This study aimed to establish the prevalence of cytomegalovirus retinitis among people with HIV in Malawi and the feasibility of screening. Methods Patients with CD4 counts <200 cells/mm3 were examined from 2 HIV clinics in Lilongwe and the main government hospital. Data were collected on antiretroviral therapy, ocular symptoms, and visual acuity. Fundoscopy was performed to investigate for features of cytomegalovirus retinitis. Retinal photographs were reviewed by an ophthalmologist. Patients diagnosed with cytomegalovirus retinitis were offered weekly ganciclovir injections, because systemic treatment was not available. Results Five of the 102 people with HIV screened had cytomegalovirus retinitis (4.9%). All affected patients had CD4 counts <50 cells/mm3 (mean, 15 cells/mm3; range, 3-22 cells/mm3). Visual acuity was unhelpful in identifying those with cytomegalovirus retinitis. Symptomatically, only blurred vision was useful. Two patients consented to treatment, 1 of which improved but relapsed after defaulting. Conclusions Cytomegalovirus retinitis screening based on CD4 count is essential to early recognition because visual acuity and symptoms are unreliable. Cytomegalovirus retinitis is a significant yet neglected public health issue in Malawi. Oral valganciclovir is essential to reduce blindness and mortality in those diagnosed but is not yet available. Further screening and advocacy are needed.
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Affiliation(s)
- Paulina Ocieczek
- Department of Ophthalmology, Szpital Klinczny im. Prof. W. Orłowskiego, Warsaw, Poland
| | | | | | - Sam Phiri
- Lighthouse Trust, Lilongwe, Malawi.,Department of Global Health, University of Washington, Seattle, USA.,Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.,Department of Public Health, College of Medicine, School of Public Health and Family Medicine, University of Malawi, Malawi
| | | | - Iwona Grabska-Liberek
- Department of Ophthalmology, Szpital Klinczny im. Prof. W. Orłowskiego, Warsaw, Poland
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Colby DJ, Vo DQ, Teoh SC, Tam NT, Liem NT, Lu D, Nguyen TT, Cosimi L, Pollack T, Libman H. Prevalence and predictors of cytomegalovirus retinitis in HIV-infected patients with low CD4 lymphocyte counts in Vietnam. Int J STD AIDS 2013; 25:516-22. [PMID: 24327723 DOI: 10.1177/0956462413515197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 11/11/2013] [Indexed: 11/16/2022]
Abstract
We describe the results of a study to determine the prevalence and characteristics of cytomegalovirus (CMV) retinitis among HIV-infected patients in Vietnam. We conducted a cross-sectional prospective study of patients with CD4 lymphocyte count ≤100 cells/mm(3)recruited from public HIV clinics. The diagnosis was made by a trained ophthalmologist using slit lamp biomicroscopy and corroborated on fundus photography. A total of 201 patients were screened. The median age was 32 years, 77% were men, median CD4 count was 47 cells/mm(3), and 62% were on antiretroviral treatment. Prevalence of CMV retinitis was 7% (14/201, 95% CI 4-11%). CMV retinitis was not associated with age, gender, injection drug use, CD4 count, WHO clinical stage, or antiretroviral treatment status. Blurring of vision and reduced visual acuity <20/40 were associated with CMV retinitis, but only 29% of patients with the diagnosis reported blurry vision and only 64% had abnormal vision. On multivariate analysis, the sole predictor for CMV retinitis was decreased visual acuity (OR 22.8,p < 0.001). In Ho Chi Minh City, CMV retinitis was found in 7% of HIV-infected patients with low CD4. HIV-infected patients with a CD4 count <100/mm(3)or who develop blurring of vision in Vietnam should be screened for CMV retinitis.
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Affiliation(s)
- Donn J Colby
- Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Diem Qh Vo
- Retina Department, Ho Chi Minh City Eye Hospital, Ho Chi Minh City, Vietnam
| | - Stephen C Teoh
- National Healthcare Group Eye Institute, Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
| | - Nguyen T Tam
- Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam
| | - Nguyen T Liem
- Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam
| | - Doanh Lu
- Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Thi T Nguyen
- Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam
| | - Lisa Cosimi
- Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Todd Pollack
- Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Howard Libman
- Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Ford N, Shubber Z, Saranchuk P, Pathai S, Durier N, O'Brien DP, Mills EJ, Pascual F, Hoen E', Holland GN, Heiden D. Burden of HIV-related cytomegalovirus retinitis in resource-limited settings: a systematic review. Clin Infect Dis 2013; 57:1351-61. [PMID: 23899681 DOI: 10.1093/cid/cit494] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) is a late-stage opportunistic infection in people living with human immunodeficiency virus (HIV)/AIDS. Lack of ophthalmological diagnostic skills, lack of convenient CMV treatment, and increasing access to antiretroviral therapy have all contributed to an assumption that CMV retinitis is no longer a concern in low- and middle-income settings. METHODS We conducted a systematic review and meta-analysis of published and unpublished studies reporting prevalence of CMV retinitis in low- and middle-income countries. Eligible studies assessed the occurrence of CMV retinitis by funduscopic examination within a cohort of at least 10 HIV-positive adult patients. RESULTS We identified 65 studies from 24 countries, mainly in Asia (39 studies, 12 931 patients) and Africa (18 studies, 4325 patients). By region, the highest prevalence was observed in Asia with a pooled prevalence of 14.0% (11.8%-16.2%). Almost a third (31.6%, 95% confidence interval [CI], 27.6%-35.8%) had vision loss in 1 or both eyes. Few studies reported immune status, but where reported CD4 count at diagnosis of CMV retinitis was <50 cells/µL in 73.4% of cases. There was no clear pattern of prevalence over time, which was similar for the period 1993-2002 (11.8%; 95% CI, 8%-15.7%) and 2009-2013 (17.6%; 95% CI, 12.6%-22.7%). CONCLUSIONS Prevalence of CMV retinitis in resource low- and middle-income countries, notably Asian countries, remains high, and routine retinal screening of late presenting HIV-positive patients should be considered. HIV programs must ensure capacity to manage the needs of patients who present late for care.
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Affiliation(s)
- Nathan Ford
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
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Durier N, Ananworanich J, Apornpong T, Ubolyam S, Kerr SJ, Mahanontharit A, Ferradini L, Ruxrungtham K, Avihingsanon A. Cytomegalovirus viremia in Thai HIV-infected patients on antiretroviral therapy: prevalence and associated mortality. Clin Infect Dis 2013; 57:147-55. [PMID: 23511301 DOI: 10.1093/cid/cit173] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Prevalence and risk factors of cytomegalovirus (CMV) viremia in patients infected with human immunodeficiency virus (HIV) starting antiretroviral therapy (ART) in developing countries are understudied. METHODS We measured CMV DNA in stored plasma specimens of 293 Thai HIV patients starting ART at CD4 counts <200 cells/mm(3). We examined Cox proportional hazard ratios (HRs) of 24 months mortality and new AIDS-defining illness (ADI). RESULTS Of 293 patients, 159 (54.3%) were male. The median age was 33 years. The median baseline CD4 count was 82 cells/mm(3), and the median HIV-1 RNA was 4.9 log10 copies/mL. In total, 273 (93.2%) patients started potent combination ART, and 20 (6.8%) started dual nucleoside reverse transcriptase inhibitor (NRTI) therapy. CMV DNA was detected in 77 of 293 patients (26.3%) at baseline, and 9 of 199 patients with available specimen (4.5%) after 6 months of ART. The median CMV DNA was 548 copies/mL (interquartile range [IQR], 129-3849) at baseline and 114 copies/mL (IQR, 75-1099) at 6 months. In univariate analysis, death was associated with baseline CDC stage C, hemoglobin <10 g/dL, lower CD4 count, and CMV viremia. In multivariate analysis, only CMV DNA >500 copies/mL was significantly associated with mortality (HR: 7.28; 95% CI, 1.32-40.29, P = .023). CD4 count was the only variable associated with new ADI (HR: 0.70 per 50 CD4 cells increase; 95% CI, .49-.997, P = .048). CONCLUSIONS In these Thai patients with advanced HIV disease, CMV viremia was frequent, and CMV DNA >500 copies/mL predicted increased mortality despite ART initiation. This calls for increased attention to screening of active CMV infection in advanced HIV patients in developing countries. Trials assessing preemptive anti-CMV therapy may be warranted.
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Affiliation(s)
- Nicolas Durier
- TREAT Asia, amfAR/The Foundation for AIDS Research, Klongtoey, Bangkok 10110, Thailand.
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Tun N, London N, Kyaw MK, Smithuis F, Ford N, Margolis T, Drew WL, Lewallen S, Heiden D. CMV retinitis screening and treatment in a resource-poor setting: three-year experience from a primary care HIV/AIDS programme in Myanmar. J Int AIDS Soc 2011; 14:41. [PMID: 21843351 PMCID: PMC3163508 DOI: 10.1186/1758-2652-14-41] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 08/15/2011] [Indexed: 11/10/2022] Open
Abstract
Background Cytomegalovirus retinitis is a neglected disease in resource-poor settings, in part because of the perceived complexity of care and because ophthalmologists are rarely accessible. In this paper, we describe a pilot programme of CMV retinitis management by non-ophthalmologists. The programme consists of systematic screening of all high-risk patients (CD4 <100 cells/mm3) by AIDS clinicians using indirect ophthalmoscopy, and treatment of all patients with active retinitis by intravitreal injection of ganciclovir. Prior to this programme, CMV retinitis was not routinely examined for, or treated, in Myanmar. Methods This is a retrospective descriptive study. Between November 2006 and July 2009, 17 primary care AIDS clinicians were trained in indirect ophthalmoscopy and diagnosis of CMV retinitis; eight were also trained in intravitreal injection. Evaluation of training by a variety of methods documented high clinical competence. Systematic screening of all high-risk patients (CD4 <100 cells/mm3) was carried out at five separate AIDS clinics throughout Myanmar. Results A total of 891 new patients (1782 eyes) were screened in the primary area (Yangon); the majority of patients were male (64.3%), median age was 32 years, and median CD4 cell count was 38 cells/mm3. CMV retinitis was diagnosed in 24% (211/891) of these patients. Bilateral disease was present in 36% of patients. Patients with active retinitis were treated with weekly intravitreal injection of ganciclovir, with patients typically receiving five to seven injections per eye. A total of 1296 injections were administered. Conclusions A strategy of management of CMV retinitis at the primary care level is feasible in resource-poor settings. With appropriate training and support, CMV retinitis can be diagnosed and treated by AIDS clinicians (non-ophthalmologists), just like other major opportunistic infections.
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Affiliation(s)
- Nini Tun
- California Pacific Medical Center, San Francisco, USA
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Abstract
The authors describe CMV retinitis in resource-poor settings and suggest possibilities for management.
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Kosobucki BR, Freeman WR. Retinal Disease in HIV-infected Patients. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50098-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hodge WG, Boivin JF, Shapiro SH, Lalonde RG, Shah KC, Murphy BD, Dionne MA, Goela A. Clinical risk factors for cytomegalovirus retinitis in patients with AIDS. Ophthalmology 2004; 111:1326-33. [PMID: 15234132 DOI: 10.1016/j.ophtha.2004.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2003] [Accepted: 03/02/2004] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To determine the clinical risk factors for cytomegalovirus (CMV) retinitis in patients with AIDS. DESIGN A case-control study. PARTICIPANTS The study included 120 patients in whom CMV retinitis had been diagnosed from 1990 through 1999 (cases) and 159 patients without CMV retinitis from the same period (controls). All individuals had AIDS and CD4 counts less than 50 cells/microl at the time of diagnosis of retinitis in the cases or on the corresponding date for the controls. METHODS Clinical risk factors were determined by history or physical examination. Confounders controlled for included CD4 count, hospital center, and a series of variables to control for confounding by drug treatment. Statistical analysis was performed by multivariate logistic regression. A systematic model-building strategy was developed from assumption testing to model building to model checking. MAIN VARIABLES MEASURED: Presence of visual symptoms, retinal microinfarctions (cotton-wool spots), history of opportunistic infections, and risk factors for human immunodeficiency virus acquisition were determined and compared in both groups. RESULTS The following clinical risk factors were significant predictors of CMV retinitis: flashing lights or floaters (odds ratio [OR], 11.42; 95% confidence interval [CI], 3.43 to 38.01), cotton-wool spots (OR, 2.90; 95% CI, 1.01 to 8.29), number of previous opportunistic infections (OR, 1.81; 95% CI, 1.24 to 2.64), previous nonocular CMV infection (OR, 82.99; 95% CI, 6.86 to 1004.58), previous Mycobacterium infection (OR, 3.41; 95% CI, 0.99 to 11.85), and homosexuality (OR, 2.83; 95% CI, 1.13 to 7.12). CONCLUSIONS Based on this study, clinical variables have been identified that elevate the risk of CMV retinitis. These findings may be useful to clinicians and health policy experts in developing rational guidelines for screening, examination frequency, and targeted prophylaxis for CMV retinitis in patients with AIDS.
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Affiliation(s)
- William G Hodge
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
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Kempen JH, Jabs DA, Wilson LA, Dunn JP, West SK, Tonascia J. Mortality risk for patients with cytomegalovirus retinitis and acquired immune deficiency syndrome. Clin Infect Dis 2003; 37:1365-73. [PMID: 14583871 DOI: 10.1086/379077] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2003] [Accepted: 07/10/2003] [Indexed: 12/17/2022] Open
Abstract
We prospectively followed up 589 patients to evaluate the relationship of anti-cytomegalovirus (CMV) treatment and immune reconstitution in response to highly active antiretroviral therapy (HAART) on the mortality risk of patients with CMV retinitis and acquired immune deficiency syndrome. The use of HAART was associated with an 81% lower mortality rate (95% confidence interval [CI], 74%-86%); it was 96% lower (95% CI, 92%-98%) for those who developed immune recovery and 49% lower (95% CI, 30-63%) for those who did not. Using time-updated multivariate analysis, current systemic anti-CMV treatment was independently associated with a 28% lower mortality rate (95% CI, 8%-43%). On the basis of these results, for patients who continue to have profound immunodeficiency despite HAART, the continued use of HAART and systemic anti-CMV therapy is predicted to reduce the risk of mortality by 65%, over and above the benefits of Pneumocystis carinii and Mycobacterium avium prophylaxis.
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Affiliation(s)
- John H Kempen
- Department of Ophthalmology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
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Kempen JH, Martin BK, Wu AW, Barron B, Thorne JE, Jabs DA. The effect of cytomegalovirus retinitis on the quality of life of patients with AIDS in the era of highly active antiretroviral therapy. Ophthalmology 2003; 110:987-95. [PMID: 12750102 DOI: 10.1016/s0161-6420(03)00089-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To evaluate the effect of cytomegalovirus (CMV) retinitis on quality of life (QOL) in patients with the acquired immune deficiency syndrome (AIDS). DESIGN Enrollment data from a multicenter, prospective cohort study. PARTICIPANTS Patients >/=13 years of age with AIDS in three groups: no CMV retinitis, 709 patients; long-standing CMV retinitis (diagnosed a median of 34.5 months previously), 212 patients; and newly diagnosed CMV retinitis (diagnosed </=45 days previously), 50 patients. METHODS Patients were enrolled at 19 centers throughout the United States. CMV retinitis status was determined by ophthalmoscopy. Vision-related QOL was assessed with a questionnaire designed for patients with CMV retinitis. General health-related QOL was evaluated with a modified version of the Medical Outcomes Survey-HIV instrument. Health utility was measured with the EuroQol instrument. MAIN OUTCOME MEASURES Patient-reported vision-related QOL, general health-related QOL, and health utility. RESULTS All domains of vision-related QOL were substantially lower in both the long-standing and newly diagnosed CMV retinitis groups than in the group with no CMV retinitis. The long-standing CMV retinitis group was similar to the no CMV retinitis group in most general health-related QOL domains and in health utility measures. The newly diagnosed CMV retinitis group scored substantially worse than the other groups in many of the general health-related QOL domains and in visual analog scale-measured health utility. Adjustment of selected scale scores for demographic characteristics and for CD4(+) T-cell count, human immunodeficiency virus viral load, and use of highly active antiretroviral therapy (HAART) attenuated most of the differences in general health-related QOL, except that physical function scores remained significantly lower in the newly diagnosed CMV retinitis group. Adjustment did not alter the pattern of vision-related QOL results. CONCLUSIONS These results suggest that in the HAART era, CMV retinitis is associated with reduced vision-related QOL in patients both with newly diagnosed and with long-standing disease, even though patients with long-standing CMV retinitis seem to have general health-related QOL and health utility similar to that of patients with AIDS who do not have CMV retinitis. Newly diagnosed CMV retinitis also is associated with lower general health-related QOL in most domains and with lower health utility.
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Affiliation(s)
- John H Kempen
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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