Cytomegaloviru reitance to ganciclovir and clinical outcome of patient with cytomegaloviru retiniti

Purpoe To evaluate whether cytomegaloviru reitant to ganciclovir, detected in either the blood or urine, correlate with advere ocular outcome. Deign Propective cohort tudy. Method Patient with cytomegaloviru and AID were enrolled in a tudy of the occurrence and clinical correlate of reitant cytomegaloviru. Blood and urine culture for cytomegaloviru were performed at the time of diagnoi of retiniti, 1 and 3 month after the initiation of therapy, and every 3 month thereafter. Patient were een monthly, at which time fundu photograph were obtained and forwarded to the Fundu Photograph Reading Center for evaluation of retiniti progreion (movement of a border of a cytomegaloviru leion ≥750 μm, or the occurrence of a new leion ≥ 0.25 dik area in ize) and the amount of retinal area affected by cytomegaloviru retiniti. Viual acuity wa meaured uing logarithmic viual acuity chart. Phenotypic reitance to ganciclovir wa defined a an IC50 >6.0 μmol/l, and genotypic reitance to ganciclovir wa defined a the occurrence of a cytomegaloviru UL97 gene mutation known to confer ganciclovir reitance. Time-dependent analye were performed and included viral reitance, highly active antiretroviral therapy, and treatment variable a predictor of clinical outcome. Reult One hundred ninety-even patient received ganciclovir therapy. Nineteen patient developed phenotypic reitance to ganciclovir, and 18 developed genotypic reitance. The detection of cytomegaloviru reitant to ganciclovir wa aociated with a 4.17- to 5.61-fold increae in the odd of retiniti progreion (P value all ≤ .0002), depending upon the definition of reitance and the culture ource analyzed. Reitance wa aociated with a greater increae in retinal area involved by cytomegaloviru by 3-month interval (1.10% v 0.05% to 0.10%), which wa ignificant for phenotypic reitance and for genotypic reitance in the blood or urine (P = .012 to .021). There wa a uggetion that reitance wa aociated with a greater lo of viual acuity (P = .009 to .096). Highly active antiretroviral therapy wa aociated with an approximate 50% reduction in the odd of retiniti progreion, and the ganciclovir implant wa aociated with an approximate 60% reduction. Concluion The detection of cytomegaloviru reitant to ganciclovir in either the blood or urine of a patient with cytomegaloviru retiniti i aociated with an increaed rik of advere ocular outcome.