Secondary CMV Retinitis Prophylaxis Can Be Halted in HAART Responders -- HIV/AIDS INFO AND UPDATES

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Date Posted: 22:12:48 02/28/02 Thu
Author: Anonymous
Subject: Secondary CMV Retinitis Prophylaxis Can Be Halted in HAART Responders

Secondary CMV Retinitis Prophylaxis Can Be Halted in HAART Responders

NEW YORK (Reuters Health) Feb 20 - Mounting evidence indicates that cytomegalovirus (CMV) prophylactic maintenance therapy can be safely discontinued in HIV-infected patients with quiescent CMV retinitis who show a sustained response to highly active antiretroviral therapy (HAART).

The latest study on the subject, from Dr. Juan Berenguer, of Hospital Gregorio Maranon in Madrid, and a Spanish team, is published in the February 1st issue of Clinical Infectious Diseases.

In an open, nonrandomized prospective study, 36 AIDS patients with quiescent CMV retinitis stopped CMV prophylaxis after a median of 75 weeks of HAART and at a median CD4+ count of 287 cells/ L.

"After a median followup of 90 weeks, no reactivation or progression of retinitis was observed in the 35 patients who showed a persistent response to antiretroviral therapy," the team reports. "One patient who experienced immunological failure relapsed during week 44 (CD4+ count, 62 cells/ L)."

In comments to Reuters Health, Dr. Berenguer said data from the current study and three other studies suggest that CMV prophylaxis may safely be halted at a CD4+ cell count >200 cells/ L and possibly at lower levels as well.

"Few of the patients enrolled in the cited studies had baseline CD4+ cell counts in the range between 100 and 200/ L," he said. "Nevertheless, it may be reasonable to discontinue secondary prophylaxis as well in those patients considering that almost all persons who subsequently have progressive CMV retinitis had CD4+ cell counts below 100 cells/ L."

Obviously, patients who discontinue CMV prophylaxis should have their CD4+ cell counts monitored periodically, Dr. Berenguer said. "In those who later develop immunologic failure, close observation for evidence of recurrent retinitis or resumption of secondary prophylaxis may be chosen depending on the risk of irrecoverable loss of vision," he added.

Clin Infect Dis 2002;34:394-397.

Reuters Health Information 2002. � 2002 Reuters Ltd
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