Visual Loss in Patients With Cytomegalovirus Retinitis and Acquired Immunodeficiency Syndrome Before Widespread Availability of Highly Active Antiretroviral Therapy

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Abstract
PRIOR TO the advent of highly active antiretroviral therapy (HAART), cytomegalovirus (CMV) retinitis was estimated to affect 30% of people with acquired immunodeficiency syndrome (AIDS) at some point during their shortened lifetimes1 and was associated with high rates of visual loss.2 More recently, the incidence of CMV retinitis has decreased by 55% to 95%, 3-5 with current estimates of the incidence at 25% of the rates seen in the early 1990s, presumably because of the widespread use of HAART and the attendant improvement in immune function.6 Data from 3 clinical trials were evaluated for information on the rates, secular trends, and causes of visual loss before the widespread availability of HAART. These data provide a comparative base to evaluate the changes in both the rates and causes of visual loss among patients with CMV retinitis that have occurred with improvements in therapy for human immunodeficiency virus (HIV), ie, HAART. Historical comparisons will be important for such evaluations because clinical trials may not be feasible or ethical. Furthermore, patients with CMV retinitis who fail to respond to HAART or develop resistant virus after responding may be expected to experience visual loss, much like the group, described here.

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