Wohl D A, Kendall M A, Owens S, Holland G, Nokta M, Spector S A, Schrier R, Fiscus S, Davis M, Jacobson M A, Currier J S, Squires K, Alston-Smith B, Andersen J, Freeman W R, Higgins M, Torriani F J
University of North Carolina, Chapel Hill, North Carolina 27516-7215, USA.
HIV Clin Trials. 2005 May-Jun;6(3):136-46. doi: 10.1310/4J65-4YX1-4ET6-E5KR.
Reconstitution of immune function during potent antiretroviral therapy can prompt discontinuation of maintenance cytomegalovirus (CMV) therapy but has also been associated with sight-threatening inflammatory conditions including immune recovery uveitis (IRU).
Patients with inactive CMV retinitis and a CD4+ cell count above 100/mm3, receiving CMV therapy and stable combination antiretroviral therapy, were assigned to one of two groups based on willingness to discontinue CMV therapy.
Thirty-eight participants were enrolled: 28 discontinued anti-CMV therapy (Group 1) and 10 continued CMV treatment (Group 2). Median on-study follow-up was 16 months. One Group 1 participant who experienced an increase in plasma HIV viral load and a decline in CD4+ cell count developed confirmed progression of CMV retinitis. Progression or reactivation CMV retinitis was not observed among Group 2. IRU was present at study entry in 3 participants. Six participants in Group 1 and 3 participants in Group 2 developed IRU on-study. CMV viremia was not detected in any participants, and urinary shedding of CMV was intermittent.
Recurrence of CMV retinitis following discontinuation of anti-CMV therapy among patients with antiretroviral-induced increases in CD4+ cell count was rare. However, IRU was common in both those who maintained and discontinued anti-CMV therapy.
强效抗逆转录病毒治疗期间免疫功能的重建可促使停止巨细胞病毒（CMV）维持治疗，但也与包括免疫恢复性葡萄膜炎（IRU）在内的威胁视力的炎症性疾病有关。
将患有非活动性CMV视网膜炎且CD4+细胞计数高于100/mm³、接受CMV治疗且抗逆转录病毒联合治疗稳定的患者，根据其停止CMV治疗的意愿分为两组。
共纳入38名参与者：28名停止抗CMV治疗（第1组），10名继续CMV治疗（第2组）。研究期间的中位随访时间为16个月。第1组中有1名参与者血浆HIV病毒载量增加且CD4+细胞计数下降，确诊为CMV视网膜炎进展。第2组中未观察到CMV视网膜炎进展或复发。3名参与者在研究入组时即患有IRU。第1组中有6名参与者和第2组中有3名参与者在研究期间发生了IRU。所有参与者均未检测到CMV病毒血症，CMV的尿液排出呈间歇性。
在抗逆转录病毒治疗导致CD4+细胞计数增加的患者中，停止抗CMV治疗后CMV视网膜炎复发的情况很少见。然而，IRU在维持和停止抗CMV治疗的患者中均很常见。
