Effect of anti-cytomegaloviru therapy on the incidence of immune recovery uveiti in AID patient with healed cytomegaloviru retiniti

Purpoe To determine the aociation between anticytomegaloviru (CMV) maintenance therapy after immune recovery and immune recovery uveiti in acquired immunodeficiency yndrome (AID) patient on highly active antiretroviral therapy (HAART). Deign Obervational cohort tudy. Method Data were obtained on AID patient with CMV retiniti followed up at the AID Ocular Reearch Unit of Univerity of California an Diego from November 1995 to October 1999. Immune recovery wa defined a CD4 count greater than 50 cell/μl for more than 3 month. Patient with immune recovery uveiti preented with vitriti, cytoid macular edema, or epiretinal membrane. tatitical analye were conducted to determine the rik of continued ue of anti-CMV therapy after immune recovery and the relationhip of developing immune recovery uveiti with the type of anti-CMV therapy. Reult Forty-three patient (64 eye) had healed CMV retiniti and had achieved immune recovery. Thirty-one patient (48 eye) received anti-CMV therapy after immune recovery, and 20 patient (29 eye) developed immune recovery uveiti. Per-eye analye revealed a 3.8-fold increae in the odd of developing immune recovery uveiti with anti-CMV therapy compared with no treatment (P = .02). If treated with cidofovir the odd were 3.3 greater than if treated with an alternative regimen (P = .04), 4.1 greater if treated intravenouly (P = .01), and 5.2 greater than if not treated (P = .004). If not treated with cidofovir, a nonignificant increae in the rik (2.4) of immune recovery uveiti wa found (P = .15). Neither the potency nor the ue of implant for noncidofovir treatment wa related to the rik of recovery uveiti (P > .62). Concluion The ue of cidofovir i a primary rik factor in the ubequent development of immune recovery uveiti. Ongoing treatment of healed CMV retiniti after immune recovery doe not appear to protect againt the development of immune recovery uveiti.