PMID- 24771331
OWN - NLM
STAT- MEDLINE
DCOM- 20150817
LR  - 20140628
IS  - 1537-6591 (Electronic)
IS  - 1058-4838 (Linking)
VI  - 59
IP  - 2
DP  - 2014 Jul 15
TI  - Proposed clinical case definition for cytomegalovirus-immune recovery retinitis.
PG  - 298-303
LID - 10.1093/cid/ciu291 [doi]
AB  - BACKGROUND: Cytomegalovirus (CMV) retinitis has been extensively described in 
      patients with advanced or late human immunodeficiency virus (HIV) disease under 
      ineffective treatment of opportunistic infection and antiretroviral therapy (ART) 
      failure. However, there is limited information about patients who develop active 
      cytomegalovirus retinitis as an immune reconstitution inflammatory syndrome 
      (IRIS) after successful initiation of ART. Therefore, a case definition of 
      cytomegalovirus-immune recovery retinitis (CMV-IRR) is proposed here. METHODS: We 
      reviewed medical records of 116 HIV-infected patients with CMV retinitis 
      attending our institution during January 2003-June 2012. We retrospectively 
      studied HIV-infected patients who had CMV retinitis on ART initiation or during 
      the subsequent 6 months. Clinical and immunological characteristics of patients 
      with active CMV retinitis were described. RESULTS: Of the 75 patients under 
      successful ART included in the study, 20 had improvement of CMV retinitis. The 
      remaining 55 patients experienced CMV-IRR; 35 of those developed CMV-IRR after 
      ART initiation (unmasking CMV-IRR) and 20 experienced paradoxical clinical 
      worsening of retinitis (paradoxical CMV-IRR). Nineteen patients with CMV-IRR had 
      a CD4 count of >/=50 cells/microL. Six patients with CMV-IRR subsequently developed 
      immune recovery uveitis. CONCLUSIONS: There is no case definition for CMV-IRR, 
      although this condition is likely to occur after successful initiation of ART, 
      even in patients with high CD4 T-cell counts. By consequence, we propose the case 
      definitions for paradoxical and unmasking CMV-IRR. We recommend close follow-up 
      of HIV-infected patients following ART initiation.
CI  - (c) The Author 2014. Published by Oxford University Press on behalf of the 
      Infectious Diseases Society of America. All rights reserved. For Permissions, 
      please e-mail: journals.permissions@oup.com.
FAU - Ruiz-Cruz, Matilde
AU  - Ruiz-Cruz M
AD  - Centro de Investigacion en Enfermedades Infecciosas, Instituto Nacional de 
      Enfermedades Respiratorias, Mexico City, Mexico.
FAU - Alvarado-de la Barrera, Claudia
AU  - Alvarado-de la Barrera C
AD  - Centro de Investigacion en Enfermedades Infecciosas, Instituto Nacional de 
      Enfermedades Respiratorias, Mexico City, Mexico.
FAU - Ablanedo-Terrazas, Yuria
AU  - Ablanedo-Terrazas Y
AD  - Centro de Investigacion en Enfermedades Infecciosas, Instituto Nacional de 
      Enfermedades Respiratorias, Mexico City, Mexico.
FAU - Reyes-Teran, Gustavo
AU  - Reyes-Teran G
AD  - Centro de Investigacion en Enfermedades Infecciosas, Instituto Nacional de 
      Enfermedades Respiratorias, Mexico City, Mexico.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140424
PL  - United States
TA  - Clin Infect Dis
JT  - Clinical infectious diseases : an official publication of the Infectious Diseases 
      Society of America
JID - 9203213
SB  - IM
MH  - Adult
MH  - CD4 Lymphocyte Count
MH  - Cytomegalovirus/immunology/*isolation & purification
MH  - Cytomegalovirus Retinitis/*diagnosis/immunology/*pathology
MH  - Female
MH  - HIV Infections/*complications/*drug therapy
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*diagnosis/*pathology
MH  - Male
OTO - NOTNLM
OT  - AIDS
OT  - ART
OT  - CMV-immune recovery retinitis
OT  - HIV
OT  - IRIS
EDAT- 2014/04/29 06:00
MHDA- 2015/08/19 06:00
CRDT- 2014/04/29 06:00
PHST- 2014/04/29 06:00 [entrez]
PHST- 2014/04/29 06:00 [pubmed]
PHST- 2015/08/19 06:00 [medline]
AID - ciu291 [pii]
AID - 10.1093/cid/ciu291 [doi]
PST - ppublish
SO  - Clin Infect Dis. 2014 Jul 15;59(2):298-303. doi: 10.1093/cid/ciu291. Epub 2014 
      Apr 24.