Discontinuation of maintenance therapy for cytomegalovirus retinitis in HIV-infected patients receiving highly active antiretroviral therapy
| Autor: | Roland Tubiana, Brigitte Autran, Geneviève Chêne, Marianne Savès, Maryem Nciri, Stéphane Lasry, Guislaine Carcelain, Marc Jouan, Brigitte Senechal, Christina Tural, Nathalie Cassoux, Anne-Marie Fillet, Christine Katlama, Camille Aubron-Olivier |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Adult
Male Human cytomegalovirus medicine.medical_specialty Anti-HIV Agents medicine.medical_treatment Immunology Cytomegalovirus Retinitis Eye Maintenance therapy Betaherpesvirinae Antiretroviral Therapy Highly Active Internal medicine medicine Humans Immunology and Allergy Prospective Studies Prospective cohort study Chemotherapy AIDS-Related Opportunistic Infections biology business.industry Incidence virus diseases Middle Aged biology.organism_classification medicine.disease CD4 Lymphocyte Count Discontinuation Surgery Infectious Diseases Cytomegalovirus Retinitis RNA Viral Female Cytomegalovirus retinitis business Follow-Up Studies |
| Zdroj: | AIDS. 15:23-31 |
| ISSN: | 0269-9370 |
| DOI: | 10.1097/00002030-200101050-00006 |
| Popis: | Objective: To study the safety of discontinuing cytomegalovirus (CMV) maintenance therapy among patients with cured CMV retinitis receiving highly active antiretroviral therapy (HAART). Methods: Patients with a history of CMV retinitis who were receiving anti-CMV maintenance therapy and who had a CD4 cell count >75 x 10 6 cells/l and a plasma HIV RNA level < 30000 copies/ml while on HAART were included in a multicentre prospective study. Maintenance therapy for CMV retinitis was discontinued at enrolment and all the patients were monitored for 48 weeks by ophthalmological examinations and by determination of CMV markers, CD4 cell counts and plasma HIV RNA levels. T helper-1 anti-CMV responses were assessed in a subgroup of patients. The primary study endpoint was recurrence of CMV disease. Results: At entry, the 48 assessable patients had been taking HAART for a median of 18 months. The median CD4 cell count was 239 × 10 6 cells/I and the median HIV RNA load was 213 copies/ml. Over the 48 weeks, 2 of the 48 patients had a recurrence of CMV disease. The cumulative probability of CMV retinitis relapse was 2.2% at week 48 (95% confidence interval, 0.4-11.3) and that of all forms of CMV disease 4.2%. CMV blood markers remained negative throughout follow-up. The proportion of patients with CMV-specific CD4 T cell reactivity was 46% at baseline and 64% at week 48. Conclusions: CMV retinitis maintenance therapy may be safely discontinued in patients with CD4 cell counts above 75 × 10 6 cells/l who have been taking HAART for at least 18 months. |
| Databáze: | OpenAIRE |
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