[Course of cytomegalovirus retinitis in HIV positive patients treated with triple antiretroviral therapy].

PURPOSE

The recent developments of protease inhibitors raise big hopes for the fight against AIDS. Combined in a triple therapy with 2 nucleoside analogs, those molecules strongly inhibit human immunodeficiency virus (HIV) replication. Their biological and clinical efficacy for increasing CD4 cell count and survival time has been proved. We have followed evolution of Cytomegalovirus (CMV) retinitis in 12 patients treated by triple antiretroviral combination therapy since April 1996.

PATIENTS AND METHODS

Twelve AIDS patients with CMV retinitis background and a treatment by triple therapy were followed in this prospective study. At the onset of combination therapy, retinitis was cicatricial in 10 patients and active in 2 patients. Mean CD4 cell count was 23 +/- 16 CD4/microL [4-50]. Follow-up included ophthalmoscopic examination every 2 weeks and fundus photographs every month. CD4 cell count was noted at each exam.

RESULTS

The mean time follow-up after onset of combination therapy was 10.3 +/- 2.4 months [5-14]. Retinitis relapsed in 6 patients (50%) within the 3 first months, and with a CD4 cells count higher than 75/microL for 3 patients. Inflammation response was noted in 3 patients. There was no recurrence after the third month, except in 1 case at the 9th month. CD4 cell count was 122 +/- 41 CD4/microL [30-350] after 6 months. As retinal lesions were completely still for some patients, maintenance therapy was reduced, then even stopped. At the end of follow-up, maintenance therapy was stopped for 8 patients. For these patients, retinitis remained stable without maintenance therapy for a mean time of 4,5 months (10 months in 1 case). Recurrence occurred for only 1 patient after 9 months of triple therapy and 2 months without maintenance therapy. For the 11 remaining patients, retinitis remained stable for a mean total time of 9.5 +/- 2.5 months [4.5-12.5].

CONCLUSION

Those first results show that clinical and therapeutic history of CMV retinitis may be changing. There seems to be a restoration of immune defenses that allowed suppression of maintenance therapy for 8 out of 12 patients. Our results need to be confirmed by a longer follow-up and multicentric studies.