This is a retrospective, cross-sectional review of medical records from a consecutive series of patients with AIDS-related cytomegalovirus (CMV) retinitis who were examined at five HIV disease clinics in Yangon, Myanmar, in November 2006. All patients with CD4+ T lymphocytes counts <50 cells/ml or visual symptoms underwent indirect ophthalmoscopy. A total of 179 patients were examined with HIV and 36/179 with CMV retinitis were on cART (Starvudine plus Lamivudine and Nevirapine) and had never received specific anti-CMV therapy. Nineteen out of 39 had active CMV retinitis and 17/36 had inactive CMV retinitis. Among patients on anti-CMV retinitis for 14 weeks or less, each of the 16 had active CMV retinitis and treated with intraocular ganciclovir. At one year review, 9/19 (47%) patients who had received anti-CMV retinitis treatment, of which four had bilateral disease. Seven patients were lost to follow-up and three died. None of the 10 eyes that had intact vision at initial examination and who had been treated with specific anti-CMV therapy had become blind at one-year follow-up. The authors concluded that eye examination should be performed routinely on all patients who are vulnerable to CMV retinitis at the time they first enter healthcare, just as screening is provided for other serious opportunistic infections.

Active cytomegalovirus retinitis after the start of antiretroviral therapy.
Heiden D, Tun N, Smithuis FN, et al.
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Jonathan Chan

Royal Hallamshire Hospital, Sheffield, UK.

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