Hassan-Moosa R, Chinappa T, Jeena L, Visser L, Naidoo K
Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.
S Afr Med J. 2017 Sep 22;107(10):843-846. doi: 10.7196/SAMJ.2017.v107i10.12740.
Retinal cytomegalovirus (CMV) infection is a common opportunistic infection and remains a significant contributor to visual loss in patients with AIDS. We highlight the poor outcomes of CMV retinitis in three HIV-infected patients who were initiated on antiretroviral therapy (ART). We conducted a retrospective chart review of advanced stage HIV-infected patients with known CMV retinitis.Case 1. A 37-year-old man, with a CD4+ cell count of 35 cells/µL, presented for ART initiation with a 5-month history of visual loss in his left eye. Fundoscopy showed left eye CMV retinitis and right eye HIV retinopathy. ART and 5 months of weekly intravitreal ganciclovir injections (left eye) were commenced. Six-month outcomes included virological suppression, and visual acuity in the right eye of 6/6 and in the left eye of 3/60.Case 2. A 31-year-old woman, with a CD4+ cell count of 39 cells/µL and on tuberculosis therapy, presented for ART initiation. She presented with a 2-month history of decreased visual acuity. Fundoscopy showed bilateral CMV retinitis, which was more pronounced in the left eye. ART and 8 months of intravitreal ganciclovir injections were commenced. Six-month outcomes included virological suppression and visual acuity in the right eye of 6/9, and in the left eye of 6/24.Case 3. A 29-year-old woman, with a CD4+ cell count of 24 cells/µL, who was on tuberculosis therapy and ART, complained of blurred vision at her 2-month ART follow-up visit. Fundoscopy showed bilateral retinal detachment secondary to CMV retinitis. While silicone oil tamponade and subsequent retinectomy successfully repaired the right eye, extensive damage rendered the left eye irreparable. Six-month outcomes included virological suppression, with 6/120 visual acuity in the right eye and complete blindness in the left eye.
CMV retinitis causes debilitating, permanent sequelae, which is preventable by ART initiation at higher CD4+ cell counts. Despite achieving virological suppression, vision could not be completely restored in these patients, irrespective of the severity of CMV retinitis.
视网膜巨细胞病毒（CMV）感染是一种常见的机会性感染，仍然是导致艾滋病患者视力丧失的重要原因。我们强调了3例开始接受抗逆转录病毒治疗（ART）的HIV感染患者中CMV视网膜炎的不良预后。我们对已知患有CMV视网膜炎的晚期HIV感染患者进行了回顾性病历审查。
病例1. 一名37岁男性，CD4+细胞计数为35个/微升，因左眼视力丧失5个月前来开始接受ART治疗。眼底检查显示左眼为CMV视网膜炎，右眼为HIV视网膜病变。开始进行ART治疗，并对左眼每周进行5个月的玻璃体内注射更昔洛韦。6个月后的结果包括病毒学抑制，右眼视力为6/6，左眼视力为3/60。
病例2. 一名31岁女性，CD4+细胞计数为39个/微升，正在接受结核病治疗，前来开始接受ART治疗。她有2个月视力下降的病史。眼底检查显示双侧CMV视网膜炎，左眼更为明显。开始进行ART治疗，并进行8个月的玻璃体内注射更昔洛韦。6个月后的结果包括病毒学抑制，右眼视力为6/9，左眼视力为6/24。
病例3. 一名29岁女性，CD4+细胞计数为24个/微升，正在接受结核病治疗和ART治疗，在ART治疗2个月的随访中抱怨视力模糊。眼底检查显示双侧视网膜脱离继发于CMV视网膜炎。虽然硅油填塞和随后的视网膜切除术成功修复了右眼，但广泛的损伤使左眼无法修复。6个月后的结果包括病毒学抑制，右眼视力为6/120，左眼完全失明。
CMV视网膜炎会导致使人衰弱的永久性后遗症，通过在较高的CD4+细胞计数时开始ART治疗可预防。尽管实现了病毒学抑制，但这些患者的视力无法完全恢复，无论CMV视网膜炎的严重程度如何。
