Cytomegalovirus Retinitis: Current State in People with HIV-AIDS in Peru

Abstract

Purpose: To describe the incidence and progression of cytomegalovirus retinitis (CMVR) in public hospital patients from Peru. Study Design: Prospective study conducted in HIV-AIDS diagnosed patients. Place and Duration of Study: Department of Ophthalmology and Department of Tropical Medicine, Hospital Nacional Dos de Mayo, from 2004 to 2013. Methodology: Descriptive statistics were obtained for age, gender, associated disease, CMVR location and ganciclovir treatment. Data were analyzed by the Pearson Chi. Square test, Mann-Whitney test, and the two-tailed exact Fischer's Exact test. SPSS version 20.0 for Windows software program was used Results: 2627 patients were evaluated, 75 had CMVR diagnosis. Active CMVR was found in 68 eyes (90.7%). Median age at diagnosis of CMVR was 37 years (IQR 30-41 years). Median CD4 level of 25 cells/μL (IQR 12.2-57.7 cells/μL), viral load > 1000,000 in 39 (52%) patients. Median mortality  rate was 7.1 deaths per 1000 PY and mean survival time from HIV diagnosis to death was 29,5 months (95%  8,7-43,0 months) and from CMVR diagnosis, 6,2 months (95%  IC 2,0-8,0 months). Duration since HIV diagnosis to CMVR onset was 12 months (IQR 3-48 months).  Tuberculosis (TB) was present in 23 (30.7%) patients. Incidence rate of HIV patients with CMVR was 28.2 cases per 1000 PY. 51 patients received ganciclovir: endovenous 34 (91.17%), intravitreal 6 (26.5%) and orally 4 (11.8%). Conclusion: CMVR has a high prevalence in young people with an elevated value of HIV-TB co-infection (30.7%). CMVR diagnosis was a predictor for early mortality, including highly active antiretroviral therapy (ART).