Jabs Douglas A, Ahuja Alka, Van Natta Mark L, Lyon Alice T, Yeh Steven, Danis Ronald
Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Center for Clinical Trials, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Center for Clinical Trials, Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Ophthalmology. 2015 Jul;122(7):1452-63. doi: 10.1016/j.ophtha.2015.02.033. Epub 2015 Apr 17.
To describe the long-term outcomes of patients with cytomegalovirus (CMV) retinitis and AIDS in the modern era of combination antiretroviral therapy.
Prospective, observational cohort study.
Patients with AIDS and CMV retinitis.
Immune recovery, defined as a CD4+ T-cell count >100 cells/μl for ≥3 months.
Mortality, visual impairment (visual acuity <20/40), and blindness (visual acuity ≤20/200) on logarithmic visual acuity charts and loss of visual field on quantitative Goldmann perimetry.
Patients without immune recovery had a mortality of 44.4/100 person-years (PYs) and a median survival of 13.5 months after the diagnosis of CMV retinitis, whereas those with immune recovery had a mortality of 2.7/100 PYs (P < 0.001) and an estimated median survival of 27.0 years after the diagnosis of CMV retinitis. The rates of bilateral visual impairment and blindness were 0.9 and 0.4/100 PYs, respectively, and were similar between those with and without immune recovery. Among those with immune recovery, the rate of visual field loss was approximately 1% of the normal field per year, whereas among those without immune recovery it was approximately 7% of the normal field per year.
Among persons with CMV retinitis and AIDS, if there is immune recovery, long-term survival is likely, whereas if there is no immune recovery, the mortality rate is substantial. Although higher than the rates in the population not infected by human immunodeficiency virus, the rates of bilateral visual impairment and blindness are low, especially when compared with rates in the era before modern antiretroviral therapy.
描述在联合抗逆转录病毒治疗的现代时代，巨细胞病毒（CMV）视网膜炎合并艾滋病患者的长期预后。
前瞻性观察队列研究。
艾滋病合并CMV视网膜炎患者。
免疫恢复定义为CD4 + T细胞计数>100个细胞/μl持续≥3个月。
对数视力表上的死亡率、视力损害（视力<20/40）、失明（视力≤20/200）以及定量戈德曼视野计测量的视野缺损。
未实现免疫恢复的患者在CMV视网膜炎诊断后的死亡率为44.4/100人年（PYs），中位生存期为13.5个月，而实现免疫恢复的患者死亡率为2.7/100 PYs（P<0.001），CMV视网膜炎诊断后的估计中位生存期为27.0年。双侧视力损害和失明的发生率分别为0.9和0.4/100 PYs，在免疫恢复和未恢复的患者中相似。在免疫恢复的患者中，每年视野缺损率约为正常视野的1%，而在未免疫恢复的患者中约为正常视野的7%。
在CMV视网膜炎合并艾滋病患者中，若实现免疫恢复，则可能长期存活，若未实现免疫恢复，则死亡率较高。尽管双侧视力损害和失明的发生率高于未感染人类免疫缺陷病毒的人群，但较低，尤其是与现代抗逆转录病毒治疗时代之前的发生率相比。
