Jabs Douglas A, Van Natta Mark L, Holland Gary N, Danis Ronald
Departments of Ophthalmology and Medicine, The 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.
Am J Ophthalmol. 2017 Feb;174:23-32. doi: 10.1016/j.ajo.2016.10.011. Epub 2016 Oct 27.
To evaluate the rates of new-onset cytomegalovirus (CMV) retinitis and worsening existing CMV retinitis in patients with AIDS after initiating combination antiretroviral therapy (cART) and the role of an immune recovery inflammatory syndrome (IRIS).
Cohort study.
Immune recovery was defined as an increase in CD4 T cells to ≥100 cells/μL; rates of new-onset CMV retinitis and of worsening of CMV retinitis (either increasing border activity or retinitis progression) were compared between those with and without immune recovery.
Among patients without CMV retinitis, 1 of 75 patients with immune recovery developed CMV retinitis in the first 6 months after initiating cART vs 1 of 31 without immune recovery (P = .14). Among patients with CMV retinitis, the rates of retinitis progression and increasing retinitis border activity among patients during the first 6 months after initiating cART in those with immune recovery were 0.11 per person-year (PY; 95% confidence interval [CI] 0-0.62) and 0.11 per PY (95% CI 0-0.62), respectively, vs 0.67 per PY (95% CI 0.22-1.56) and 0.40 per PY (95% CI 0.08-1.17), respectively, for those without immune recovery (P = .11 and .47).
Among persons with AIDS who experience immune recovery, there was neither an increased rate of new-onset CMV retinitis nor worsening of existing CMV retinitis in the first 6 months after initiating cART vs those without immune recovery. These data are consistent with the known 3- to 6-month lag in recovery of specific immunity to CMV after initiating cART and suggest that "immune recovery retinitis," a proposed immune recovery inflammatory syndrome phenomenon, is rare.
评估接受联合抗逆转录病毒疗法（cART）的艾滋病患者中，新发巨细胞病毒（CMV）视网膜炎的发生率以及已有的CMV视网膜炎病情恶化情况，并评估免疫重建炎症综合征（IRIS）的作用。
队列研究。
免疫重建定义为CD4 T细胞增加至≥100个细胞/μL；比较有免疫重建和无免疫重建患者中，新发CMV视网膜炎的发生率以及CMV视网膜炎病情恶化（边界活性增加或视网膜炎进展）的发生率。
在无CMV视网膜炎的患者中，75例有免疫重建的患者中有1例在开始cART后的前6个月内发生了CMV视网膜炎，而31例无免疫重建的患者中有1例（P = 0.14）。在有CMV视网膜炎的患者中，有免疫重建的患者在开始cART后的前6个月内，视网膜炎进展率和视网膜炎边界活性增加率分别为每人年0.11（95%置信区间[CI] 0 - 0.62）和每人年0.11（95% CI 0 - 0.62），而无免疫重建的患者分别为每人年0.67（95% CI 0.22 - 1.56）和每人年0.40（95% CI 0.08 - 1.17）（P = 0.11和0.47）。
在经历免疫重建的艾滋病患者中，与无免疫重建的患者相比，开始cART后的前6个月内，新发CMV视网膜炎的发生率没有增加，已有的CMV视网膜炎病情也没有恶化。这些数据与开始cART后针对CMV的特异性免疫恢复存在3至6个月延迟这一已知情况相符，并表明一种被称为“免疫重建视网膜炎”的免疫重建炎症综合征现象较为罕见。
