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. 2001 Apr;85(4):471–473. doi: 10.1136/bjo.85.4.471

Suspension of anticytomegalovirus maintenance therapy following immune recovery due to highly active antiretroviral therapy

A Curi, A Muralha, L Muralha, C Pavesio
PMCID: PMC1723929  PMID: 11264139

Abstract

AIM—To describe the authors' experience with discontinuation of anti-cytomegalovirus (CMV) maintenance therapy in patients showing immune recovery following highly active antiretroviral therapy (HAART).
METHODS—Retrospective analysis of the records of 41 patients who presented with CMV retinitis and whose maintenance therapy was discontinued from March 1997 to December 1999.
RESULTS—41 patients had their anti-CMV therapy discontinued. The mean follow up after discontinuation of maintenance therapy in April 2000 was 20.4 months. At the time of discontinuation of maintenance therapy the lowest CD4+ count was 143 cells ×106/l and only three patients had detectable HIV viral load. No reactivation or progression was seen in any of these patients after suspension of maintenance therapy.
CONCLUSION—The anti-CMV maintenance therapy could be discontinued safely in patients with CD4+ above 150 cells ×106/l although close follow up remains necessary especially in patients whose CD4+ count drops below this level.



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Selected References

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  1. Karavellas M. P., Lowder C. Y., Macdonald C., Avila C. P., Jr, Freeman W. R. Immune recovery vitritis associated with inactive cytomegalovirus retinitis: a new syndrome. Arch Ophthalmol. 1998 Feb;116(2):169–175. doi: 10.1001/archopht.116.2.169. [DOI] [PubMed] [Google Scholar]
  2. Komanduri K. V., Viswanathan M. N., Wieder E. D., Schmidt D. K., Bredt B. M., Jacobson M. A., McCune J. M. Restoration of cytomegalovirus-specific CD4+ T-lymphocyte responses after ganciclovir and highly active antiretroviral therapy in individuals infected with HIV-1. Nat Med. 1998 Aug;4(8):953–956. doi: 10.1038/nm0898-953. [DOI] [PubMed] [Google Scholar]
  3. Macdonald J. C., Karavellas M. P., Torriani F. J., Morse L. S., Smith I. L., Reed J. B., Freeman W. R. Highly active antiretroviral therapy-related immune recovery in AIDS patients with cytomegalovirus retinitis. Ophthalmology. 2000 May;107(5):877–883. doi: 10.1016/s0161-6420(00)00023-3. [DOI] [PubMed] [Google Scholar]
  4. Macdonald J. C., Torriani F. J., Morse L. S., Karavellas M. P., Reed J. B., Freeman W. R. Lack of reactivation of cytomegalovirus (CMV) retinitis after stopping CMV maintenance therapy in AIDS patients with sustained elevations in CD4 T cells in response to highly active antiretroviral therapy. J Infect Dis. 1998 May;177(5):1182–1187. doi: 10.1086/515281. [DOI] [PubMed] [Google Scholar]
  5. Mitchell S. M., Membrey W. L., Youle M. S., Obi A., Worrell S., Gazzard B. G. Cytomegalovirus retinitis after the initiation of highly active antiretroviral therapy: a 2 year prospective study. Br J Ophthalmol. 1999 Jun;83(6):652–655. doi: 10.1136/bjo.83.6.652. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Petit N., Zandotti C., Riss J. M., Frippiat F., Moulin J. F., Gastaut J. A. Relapse of CMV retinitis in an AIDS patient with high CD4 counts. J Antimicrob Chemother. 1998 Jun;41(6):666–667. doi: 10.1093/jac/41.6.666. [DOI] [PubMed] [Google Scholar]
  7. Postelmans L., Gerard M., Sommereijns B., Caspers-Velu L. Discontinuation of maintenance therapy for CMV retinitis in AIDS patients on highly active antiretroviral therapy. Ocul Immunol Inflamm. 1999 Dec;7(3-4):199–203. doi: 10.1076/ocii.7.3.199.4014. [DOI] [PubMed] [Google Scholar]
  8. Song M. K., Karavellas M. P., MacDonald J. C., Plummer D. J., Freeman W. R. Characterization of reactivation of cytomegalovirus retinitis in patients healed after treatment with highly active antiretroviral therapy. Retina. 2000;20(2):151–155. [PubMed] [Google Scholar]
  9. Tural C., Romeu J., Sirera G., Andreu D., Conejero M., Ruiz S., Jou A., Bonjoch A., Ruiz L., Arnó A. Long-lasting remission of cytomegalovirus retinitis without maintenance therapy in human immunodeficiency virus-infected patients. J Infect Dis. 1998 Apr;177(4):1080–1083. doi: 10.1086/517399. [DOI] [PubMed] [Google Scholar]
  10. Vrabec T. R., Baldassano V. F., Whitcup S. M. Discontinuation of maintenance therapy in patients with quiescent cytomegalovirus retinitis and elevated CD4+ counts. Ophthalmology. 1998 Jul;105(7):1259–1264. doi: 10.1016/S0161-6420(98)97031-2. [DOI] [PubMed] [Google Scholar]
  11. Whitcup S. M., Fortin E., Lindblad A. S., Griffiths P., Metcalf J. A., Robinson M. R., Manischewitz J., Baird B., Perry C., Kidd I. M. Discontinuation of anticytomegalovirus therapy in patients with HIV infection and cytomegalovirus retinitis. JAMA. 1999 Nov 3;282(17):1633–1637. doi: 10.1001/jama.282.17.1633. [DOI] [PubMed] [Google Scholar]

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