| Autor: |
Whitcup, Scott M., Fortin, Eric, 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, Vrabec, T, Davey, R T Jr, Falloon, J, Walker, R E, Kovacs, J A, Lane, H C, Nussenblatt, R B, Smith, J |
| Předmět: |
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| Zdroj: |
JAMA: Journal of the American Medical Association; 11/3/99, Vol. 282 Issue 17, p1633-1637, 5p |
| Abstrakt: |
Context: Persons with cytomegalovirus (CMV) retinitis and acquired immunodeficiency syndrome (AIDS) have required lifelong anti-CMV therapy to prevent the progression of retinal disease and subsequent loss of vision.Objective: To determine whether patients who were taking highly active antiretroviral therapy (HAART) and who had stable CMV retinitis could safely discontinue anti-CMV therapy without reactivation of their retinitis or increase in human immunodeficiency virus (HIV) viral load.Design: Prospective nonrandomized interventional trial performed from July 1997 to August 1999.Setting: Clinical Center of the National Institutes of Health, Bethesda, Md.Patients: Fourteen patients with stable CMV retinitis and HIV infection and CD4+ cell counts higher than 0.1 5 x 10(9)/L and being treated with systemic anti-CMV medications and HAART.Interventions: Discontinuation of specific anti-CMV therapy.Main Outcome Measures: Reactivation of CMV retinitis, development of extraocular CMV infection, detection of CMV in blood and urine, HIV burden, immunologic function, quality of life, morbidity, and mortality.Results: Twelve (89.7%) of 14 patients had evidence of immune recovery uveitis before anti-CMV drugs were discontinued. No patient had reactivation of CMV retinitis or development of extraocular CMV disease during mean follow-up of 16.4 months (range, 8.3-22.0 months) without anti-CMV therapy. Human immunodeficiency viral load remained stable following cessation of anti-CMV medications. Blood and urine assays for CMV were briefly positive in 9 patients but did not predict reactivation of CMV disease. Worsening immune recovery uveitis was associated with a substantial (>3 lines) vision loss in 3 patients.Conclusions: Maintenance anti-CMV medications were safely stopped in those patients who had stable CMV retinitis and elevated CD4+ cell counts and who were taking HAART. The study demonstrates that immune recovery following potent antiretroviral therapy is effective in controlling a major opportunistic infection, even in patients with a history of severe immunosuppression. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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