Relapses of CMV retinitis after 2 years of highly active antiretroviral therapy

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Abstract
A 29 year old, HIV infected woman was affected by CMV retinitis in the left eye in August 1996. Her CD4+ T lymphocyte count was 15 cells ×106/l at that time. CMV retinitis was treated with intravenous foscarnet. HAART was initiated in June 1996 (d4T, 3TC, and ritonavir). In June 1997, her CD4+ cell count increased to 400 cells ×106/l and the HIV-1 viral load became undetectable. CMV maintenance therapy was discontinued in December 1997 without any relapse until May 1999 when a relapse of CMV retinitis, associated with inferior retinal detachment, was noted. At that time, her CD4+ cell count was 380 cells ×106/l, CMV viraemia was negative, but HIV viral load had increased to 31 000 copies/ml. The lymphoproliferative test against CMV antigens was negative. The patient was treated with intravenous ganciclovir and vitreoretinal surgery was performed. CMV DNA was found in the vitreous by polymerase chain reaction.

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