Waib Luis Fernando, Bonon Sandra Helena Alves, Salles Angela Christina, Benard Gil, de Oliveira Augusto César Penalva, Pannuti Claudio Sergio, Pedro Rogério de Jesus, Costa Sandra Cecília Botelho
Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil.
Rev Inst Med Trop Sao Paulo. 2007 Jul-Aug;49(4):215-9. doi: 10.1590/s0036-46652007000400004.
Before the introduction of highly active antiretroviral therapy (HAART), CMV retinitis was a common complication in patients with advanced HIV disease and the therapy was well established; it consisted of an induction phase to control the infection with ganciclovir, followed by a lifelong maintenance phase to avoid or delay relapses.
To determine the safety of CMV maintenance therapy withdrawal in patients with immune recovery after HAART, 35 patients with treated CMV retinitis, on maintenance therapy, with CD4+ cell count greater than 100 cells/mm(3) for at least three months, but almost all patients presented these values for more than six months and viral load < 30000 copies/mL, were prospectively evaluated for the recurrence of CMV disease. Maintenance therapy was withdrawal at inclusion, and patients were monitored for at least 48 weeks by clinical and ophthalmologic evaluations, and by determination of CMV viremia markers (antigenemia-pp65), CD4+/CD8+ counts and plasma HIV RNA levels. Lymphoproliferative assays were performed on 26/35 patients.
From 35 patients included, only one had confirmed reactivation of CMV retinitis, at day 120 of follow-up. No patient returned positive antigenemia tests. No correlation between lymphoproliferative assays and CD4+ counts was observed.
CMV retinitis maintenance therapy discontinuation is safe for those patients with quantitative immune recovery after HAART.
在高效抗逆转录病毒疗法（HAART）引入之前，巨细胞病毒性视网膜炎是晚期HIV疾病患者的常见并发症，且治疗方法已确立；治疗包括用更昔洛韦控制感染的诱导期，随后是避免或延迟复发的终身维持期。
为了确定HAART后免疫恢复患者停用巨细胞病毒维持治疗的安全性，对35例接受过巨细胞病毒性视网膜炎治疗且正在接受维持治疗的患者进行前瞻性评估，这些患者的CD4 +细胞计数至少三个月大于100个细胞/mm³，但几乎所有患者的这些值均超过六个月且病毒载量<30000拷贝/mL，以评估巨细胞病毒疾病的复发情况。纳入时停用维持治疗，并通过临床和眼科评估、测定巨细胞病毒病毒血症标志物（抗原血症-pp65）、CD4 + / CD8 +计数和血浆HIV RNA水平对患者进行至少48周的监测。对35例患者中的26例进行了淋巴细胞增殖试验。
纳入的35例患者中，只有1例在随访第120天确诊为巨细胞病毒性视网膜炎复发。没有患者抗原血症检测呈阳性。未观察到淋巴细胞增殖试验与CD4 +计数之间的相关性。
对于HAART后免疫定量恢复的患者，停用巨细胞病毒性视网膜炎维持治疗是安全的。
