Non-cytomegalovirus ocular opportunistic infections in patients with acquired immunodeficiency syndrome

Am J Ophthalmol. 2013 Feb;155(2):206-212.e5. doi: 10.1016/j.ajo.2012.07.019. Epub 2012 Oct 12.

Abstract

Purpose: To report the incidence and clinical outcomes of non-cytomegalovirus (non-CMV) ocular opportunistic infections in patients with acquired immunodeficiency syndrome (AIDS) in the era of highly active antiretroviral therapy.

Design: Multicenter, prospective, observational study of patients with AIDS.

Methods: Medical history, ophthalmologic examination, and laboratory tests were performed at enrollment and every 6 months subsequently. Once an ocular opportunistic infection was diagnosed, patients were seen every 3 months for outcomes.

Results: At enrollment, 37 non-CMV ocular opportunistic infections were diagnosed: 16 patients, herpetic retinitis; 11 patients, toxoplasmic retinitis; and 10 patients, choroiditis. During the follow-up period, the estimated incidences (and 95% confidence intervals [CI]) of these were: herpetic retinitis, 0.007/100 person-years (PY) (95% CI 0.0004, 0.039); toxoplasmic retinitis, 0.007/100 PY (95% CI 0.004, 0.039); and choroiditis, 0.014/ 100 PY (95% CI 0.0025, 0.050). The mortality rates appeared higher among those patients with newly diagnosed or incident herpetic retinitis and choroiditis (rates = 21.7 deaths/100 PY [P = .02] and 12.8 deaths/100 PY [P = .04]), respectively, than those for patients with AIDS without an ocular opportunistic infection (4.1 deaths/100 PY); toxoplasmic retinitis did not appear to be associated with greater mortality (6.4/100 PY, P = .47). Eyes with newly diagnosed herpetic retinitis appeared to have a poor visual prognosis, with high rates of visual impairment (37.9/100 PY) and blindness (17.5/100 PY), whereas those outcomes in eyes with choroiditis appeared to be lower (2.3/100 PY and 0/100 PY, respectively).

Conclusions: Although uncommon, non-CMV ocular opportunistic infections may be associated with high rates of visual loss and/or mortality.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy
  • AIDS-Related Opportunistic Infections / epidemiology*
  • AIDS-Related Opportunistic Infections / virology
  • Adult
  • Antiretroviral Therapy, Highly Active
  • Antiviral Agents / therapeutic use
  • CD4 Lymphocyte Count
  • Choroiditis / drug therapy
  • Choroiditis / epidemiology*
  • Choroiditis / virology
  • Cytomegalovirus Retinitis / drug therapy
  • Cytomegalovirus Retinitis / epidemiology
  • Cytomegalovirus Retinitis / virology
  • Drug Therapy, Combination
  • Female
  • Herpes Simplex / drug therapy
  • Herpes Simplex / epidemiology*
  • Herpes Simplex / virology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Mycobacterium avium-intracellulare Infection / drug therapy
  • Mycobacterium avium-intracellulare Infection / epidemiology*
  • Mycobacterium avium-intracellulare Infection / virology
  • Prospective Studies
  • Retinitis / drug therapy
  • Retinitis / epidemiology*
  • Retinitis / virology
  • Survival Rate
  • Toxoplasmosis, Ocular / drug therapy
  • Toxoplasmosis, Ocular / epidemiology*
  • Toxoplasmosis, Ocular / virology
  • United States / epidemiology
  • Visual Acuity / physiology
  • Visual Fields / physiology

Substances

  • Antiviral Agents