巨细胞病毒免疫恢复性视网膜炎的拟议临床病例定义。

Proposed clinical case definition for cytomegalovirus-immune recovery retinitis.

机构信息

Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico.

出版信息

Clin Infect Dis. 2014 Jul 15;59(2):298-303. doi: 10.1093/cid/ciu291. Epub 2014 Apr 24.

DOI:10.1093/cid/ciu291

PMID:24771331

Abstract

BACKGROUND

Cytomegalovirus (CMV) retinitis has been extensively described in patients with advanced or late human immunodeficiency virus (HIV) disease under ineffective treatment of opportunistic infection and antiretroviral therapy (ART) failure. However, there is limited information about patients who develop active cytomegalovirus retinitis as an immune reconstitution inflammatory syndrome (IRIS) after successful initiation of ART. Therefore, a case definition of cytomegalovirus-immune recovery retinitis (CMV-IRR) is proposed here.

METHODS

We reviewed medical records of 116 HIV-infected patients with CMV retinitis attending our institution during January 2003-June 2012. We retrospectively studied HIV-infected patients who had CMV retinitis on ART initiation or during the subsequent 6 months. Clinical and immunological characteristics of patients with active CMV retinitis were described.

RESULTS

Of the 75 patients under successful ART included in the study, 20 had improvement of CMV retinitis. The remaining 55 patients experienced CMV-IRR; 35 of those developed CMV-IRR after ART initiation (unmasking CMV-IRR) and 20 experienced paradoxical clinical worsening of retinitis (paradoxical CMV-IRR). Nineteen patients with CMV-IRR had a CD4 count of ≥50 cells/µL. Six patients with CMV-IRR subsequently developed immune recovery uveitis.

CONCLUSIONS

There is no case definition for CMV-IRR, although this condition is likely to occur after successful initiation of ART, even in patients with high CD4 T-cell counts. By consequence, we propose the case definitions for paradoxical and unmasking CMV-IRR. We recommend close follow-up of HIV-infected patients following ART initiation.

摘要

背景

巨细胞病毒（CMV）视网膜炎在机会性感染和抗逆转录病毒治疗（ART）失败的晚期或晚期人类免疫缺陷病毒（HIV）疾病患者中已有广泛描述。然而，对于在成功启动 ART 后发展为活跃性 CMV 视网膜炎作为免疫重建炎症综合征（IRIS）的患者，信息有限。因此，这里提出了 CMV-免疫恢复性视网膜炎（CMV-IRR）的病例定义。

方法

我们回顾了 2003 年 1 月至 2012 年 6 月期间在我们机构就诊的 116 例 HIV 感染合并 CMV 视网膜炎患者的病历。我们回顾性研究了在 ART 启动或随后 6 个月期间患有 CMV 视网膜炎的 HIV 感染患者。描述了患有活动性 CMV 视网膜炎的患者的临床和免疫学特征。

结果

在纳入研究的 75 例成功接受 ART 的患者中，有 20 例 CMV 视网膜炎得到改善。其余 55 例患者发生 CMV-IRR；其中 35 例在 ART 启动后发生 CMV-IRR（揭开 CMV-IRR），20 例出现视网膜炎的矛盾临床恶化（矛盾 CMV-IRR）。19 例 CMV-IRR 患者的 CD4 计数≥50 个/µL。6 例 CMV-IRR 患者随后发生免疫恢复性葡萄膜炎。