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Cytomegalovirus Retinitis due to Initiation of Antiretroviral Therapy

A case study on CMV retinitis in an HIV+ patient after starting antiretroviral therapy, with treatment details and conclusions on immune responses and maintenance therapy. Clinical findings and recommended management are discussed.

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Cytomegalovirus Retinitis due to Initiation of Antiretroviral Therapy

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  1. Cytomegalovirus Retinitis duetoInitiation of Antiretroviral Therapy Beatriz RodriguezAguado., Pamela Campos Figueroa., SuhelElnayefElsakan, MouafkAsaad ConsorciSanitari de Terrassa, Barcelona • 47 yearsoldman HIV+: Blurredvision in hislefteyefor 2 weeks: 0.1 (decimal scale) • Previouslydiagnosedwith miliar tuberculosis. AIDS C3 • 2 monthsbefore: Antiretroviral therapy (ART) wasinitiated • RNA copies 38000 CD4 80 cells/mm3

  2. Retinitis • Retinal hemorrhages • Macular edema

  3. he

  4. Cytomegalovirus Retinitis duetoInitiation of Antiretroviral Therapy Beatriz RodriguezAguado., Pamela Campos Figueroa., SuhelElnayefElsakan, MouafkAsaad Treatment • CMV retinitis diagnosis wasmadeclinically • InductiontherapywithintravenousGanciclovir 225mg /12h for 4 weeks • Maintenancetherapywith oral Valganciclovir 450mg/day • After 10 months: CD4+ 112 (16%) RNA undetectable

  5. 2 monthslater

  6. Cytomegalovirus Retinitis duetoInitiation of Antiretroviral Therapy Beatriz RodriguezAguado., Pamela Campos Figueroa., SuhelElnayefElsakan, MouafkAsaad CONCLUSIONS • Improvement of immune responses may lead to Immune reconstitution inflammatory syndrome (IRIS) • CMV retinitis ocurred4-7 weeks after initiation of ART; being very common when CD4 counts are less than 50 cells/mm3 • Maintenance oral therapy with Ganciclovir can be discontinued if CD4 ≥ 100-150 and ophthalmologic examination shows clinical remission

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