Tural C, Romeu J, Sirera G, Andreu D, Conejero M, Ruiz S, Jou A, Bonjoch A, Ruiz L, Arnó A, Clotet B
Ophthalmologic Department, Germans Trias i Pujol University Hospital, Badalona, Spain.
J Infect Dis. 1998 Apr;177(4):1080-3. doi: 10.1086/517399.
Seven AIDS patients who were receiving suppressive therapy for previously diagnosed cytomegalovirus (CMV) retinitis were offered treatment with protease inhibitors (PIs). Secondary prophylaxis for CMV was discontinued after 3 months of therapy with PIs if patients had >150 CD4 cells/mm3 and a human immunodeficiency virus (HIV) load of <200 copies/mL and if they were negative for CMV as determined by qualitative CMV polymerase chain reaction (PCR). Ophthalmologic exams were done periodically. After a median follow-up of 9 months (range, 9-12), no new episodes of CMV retinitis were observed. CD4 cell counts were >150 cells/mm3 in all cases, HIV loads were <200 copies/mL, and results for qualitative CMV PCRs remained negative. These observations suggest that for selected patients with healed CMV retinitis who have immunologic and virologic evidence of a clinical response to potent combination antiretroviral therapy, temporary discontinuation of a chronic anti-CMV suppressive therapy may not result in further retinal necrosis. However, the long-term immunologic benefit of PIs and hence the safety of prolonged withdrawal of anti-CMV therapy is unknown.
七名先前诊断为巨细胞病毒（CMV）视网膜炎并接受抑制疗法的艾滋病患者接受了蛋白酶抑制剂（PI）治疗。如果患者的CD4细胞计数>150个/mm³、人类免疫缺陷病毒（HIV）载量<200拷贝/mL，且通过定性CMV聚合酶链反应（PCR）检测CMV呈阴性，则在接受PI治疗3个月后停止CMV的二级预防。定期进行眼科检查。在中位随访9个月（范围9 - 12个月）后，未观察到新的CMV视网膜炎发作。所有病例的CD4细胞计数均>150个/mm³，HIV载量<200拷贝/mL，定性CMV PCR结果仍为阴性。这些观察结果表明，对于选定的已治愈CMV视网膜炎且有免疫和病毒学证据显示对强效联合抗逆转录病毒疗法有临床反应的患者，暂时停用慢性抗CMV抑制疗法可能不会导致进一步的视网膜坏死。然而，PI的长期免疫益处以及因此长期停用抗CMV疗法的安全性尚不清楚。
