AEGiS-13IAC: Absence of reactivation of cytomegalovirus (CMV) retinitis after discontinuation of CMV maintenance therapy in patients on HAART.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Absence of reactivation of cytomegalovirus (CMV) retinitis after discontinuation of CMV maintenance therapy in patients on HAART.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. TuOrB359)

Perez H, Zala C, Ochoa C, Puente S, Vazquez M, Cahn P
H. Perez, Hospital Fernandez, Angel Peluffo 3932 (1202), Buenos Aires, Argentina, Argentina, Tel.: +54 11 4981-7777, Fax: +54 11 4982-4024, E-mail: pcahn@huesped.org.ar

INTRODUCTION: Immune reconstitution following control of viral replication suggests that maintenance therapy (MT) for CMV retinitis can be discontinued. In view of the absence of controlled studies, clinical reports assessing clinical outcome of HIV patients with CMV retinitis are needed.

OBJECTIVES: To determine the relapse rate of CMV-retinitis in patients on HAART who discontinue MT.

METHODS: Patients with a diagnosis of CMV retinitis followed at an outpatient clinic in a University affiliated hospital were offered to discontinue MT if they met all the following criteria: pVL > 50 cps/ml, CD4 count >150 and stable ocular disease. Fundoscopic exams were done on a monthly basis. Relapse-free time since last episode of disease activity and since MT discontinuation were calculated.

RESULTS: From Nov. 97 to Jun. 99, 19patients were eligible to discontinue MT. Median time on HAART at the time of MT discontinuation was 360 days (range 60-720). Median CD4 cell count at baseline was 299cells/ml (150-495). Eleven patients had unilateral disease and 8 had bilateral involvement. The lesions involved Zone-1 of the retina in 19 eyes and more than 1 zone in 16. After a median follow up of 17 months ( 6-25) all eighteen patients remain disease free; including a subgroup of 2 patients who had MT discontinued after only 2 months since the addition of protease inhibitors to their 2 nucleoside reverse transcriptase inhibitors regimen. The mean time since the last episode of CMV-disease activity is 24.9 months (10-33). CD4 counts remained stable in all patients and pVL stayed undetectable through the study period in all patients but two, who returned to undetectable levels after adjustment of his antiretroviral regimen.

CONCLUSION: This cohort of patients adds evidence in favor of stopping MT against CMV in patients responsive to HAART. This recommendation, which is so far largely dependent on anecdotal reports and small case series, appears to be safe for patients with undetectable viral loads and CD4 counts > 150 cells/ml. How soon after achieving these parameters MT can be stopped is still unclear.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Cytomegalovirus Retinitis, Cytomegalovirus, CD4 Lymphocyte Count, Viral Load, Anti-HIV Agents, Reverse Transcriptase Inhibitors, HIV, HIV Protease Inhibitors, Drug Therapy, Combination, HIV Infections, Virus Replication, Case-Control Studies, Human, virology, therapy, drug therapy
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TuOrB359