Walmsley Sharon L, Raboud Janet, Angel Jonathan B, Mazzulli Tony, Shen Sandy, Casciaro Lidia, Young Charlene D, Moussa George, Gough Kevin, Rachlis Anita, Hopkins Jill
Department of Medicine, Toronto Hospital, University Health Network, University of Toronto, Canada.
HIV Clin Trials. 2006 Jan-Feb;7(1):1-9. doi: 10.1310/9M23-QN0X-W6N8-80JD.
To determine the long-term safety of discontinuation of maintenance therapy for cytomegalovirus retinitis (CMVR) and to identify predictors for relapse.
This was a prospective cohort study. Patients with treated CMVR who responded to HAART were followed by ophthalmologic assessment, markers for CMV replication (blood and urine cultures, CMV antigenemia, CMV DNA by PCR), and in vitro lymphoproliferative responses to CMV and other antigens after discontinuation of CMVR maintenance therapy.
23 patients were followed a median of 34 (range, 5-61) months. Median CD4 count was 321/mm3 at enrollment and 395/mm3 at last follow-up. HIV RNA was <50 copies/mL in 78% of patients at enrollment and 65% at last follow-up. One CMVR reactivation occurred at 12 months at a CD4 count of 395/mm3 (21%) and HIV RNA <50 copies/mL. Urine cultures were a poor predictive marker for reactivation. Other CMV replication markers had good negative predictive value. 96% of patients had a good lymphoproliferative response to CMV antigen in vitro.
Maintenance therapy for CMVR can safely be discontinued in patients who have responded to HAART. Combining our results with the published literature, the risk of reactivation is estimated at 0.016 per person year of follow-up. Markers to predict relapse and the need for re-initiation of maintenance therapy are not yet identified.
确定巨细胞病毒性视网膜炎（CMVR）维持治疗停药后的长期安全性，并识别复发的预测因素。
这是一项前瞻性队列研究。对接受过治疗且对高效抗逆转录病毒治疗（HAART）有反应的CMVR患者，在CMVR维持治疗停药后，进行眼科评估、CMV复制标志物（血和尿培养、CMV抗原血症、PCR检测CMV DNA）以及对CMV和其他抗原的体外淋巴细胞增殖反应监测。
23例患者的中位随访时间为34（范围5 - 61）个月。入组时CD4细胞计数中位数为321/mm³，末次随访时为395/mm³。入组时78%的患者HIV RNA <50拷贝/mL，末次随访时为65%。1例CMVR复发发生在12个月时，CD4细胞计数为395/mm³（21%），HIV RNA <50拷贝/mL。尿培养对复发的预测价值较差。其他CMV复制标志物具有良好的阴性预测价值。96%的患者在体外对CMV抗原具有良好的淋巴细胞增殖反应。
对HAART有反应的患者可以安全地停用CMVR维持治疗。将我们的结果与已发表的文献相结合，复发风险估计为每人每年随访0.016。尚未确定预测复发和重新开始维持治疗必要性的标志物。
