Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

568 Abstracts 32239-32243

12th World AIDS Conference

Conclusion: Surgical procedures not involving the use of silicone oil ultimately
result in redetachment of the retina. However, the treatment choosen depends on
the overall health status and survival of the patient. In cases of beginning retinal
detachment in cmv retinitis it is possible to stop progression of detachment with
good functional success.
32239 1 Prolonged dosing schedules using cidofovir in patients
with CMV retinitis (CMVR)
Ronni Lieberman, J. Orellana, J.B. Roseman. Vitreo-Retinal Consultants, PC
944 Park Ave, Mt. Sinai School of Medicine, New York, NY, USA
Objective: To ascertain if the dosing schedule of cidofovir could safely be extended from two to either three or four weeks for maintenance therapy, once the
patient was induced and found to have inactive disease.
Design: Prospective cohort.
Methods: A prolonged dosing schedule was offered to 10 patients with inactive
CMVR being treated with cidofovir. Prolonged dosing schedule was defined as
an interval of at least 3 (usually 4) weeks between infusions of drug. Patients all
had the appropriate dosage of drug calculated on the basis of their weight and
creatinine clearance. Patients were all followed carefully at biweekly intervals with
bloodwork and full ophthalmic examinations. The main outcome measure was
defined as reactivation of CMVR.
Results: Eight patients of ten (80%) elected to prolong their dosing interval.
Four patients were on 5 mg/kg, and four were on 3 mg/kg. Patients were followed on this regimen for 12 to 30 weeks. None developed active CMV retinitis,
regardless of CD-4 counts, which ranged from 20 to 399.
Conclusion: Intravenous cidofovir has potentially severe ocular and systemic
toxicities associated with it. Prolonging the dosing interval may be a cost effective method of improving the safety profile of the drug without compromising its
efficacy.
S32240 Evaluation of clinical and subclinical ophthalmologic
alterations in HIV patients
Martin Meerhoff, Carlos Eduardo Savio, G. De Feo, A. Tondo, P. Cappuccio,
I. Mirazzo. Ministerio De Salud Pubilca, SEIC, Hosp. Dia., H. Irigoyen 1403 Ap.
704, Montevideo 11400, Uruguay
Background: The incidence of ocular pathology in HIV infection varies from 40
to 75% in different series. In Uruguay this fact is still unknown. Therefore, a
prospective study was designed in order to establish this incidence in a sample
of people with HIV seen at the Day Care Health Center (DCHC). The second
objective was to determine the importance of ocular screening examination in
asymptomatic patients since there are subclinical ocular alterations which should
be treated.
Methods: We analyzed prospectively 88 patients sent to ophthalmologic examination in DCHC between 07/96 and 12/97. A special form was designed
to record information about general epidemiological facts, ocular examination
including fundus findings and treatment. In order to classify disease stages the
Classification System for HIV Infection (Center for Diseases Control, 1993) was
used. For fundus examination an indirect ophthalmoscope was used.
Results: 88 patients (pts) were studied. 39 female and 48 male. Ages ranged
from 1 month to 49 years old. 60 pts had CD4 counts and were classified in the
following stages: Al (03), A2 (29), A3 (11), C2 (03), C3 (14). 30 pts were under
antiretroviral therapy. The main causes of referral to ophthalmology were: reduced
visual acuity (27 pts, 30.06%); screening (16 pts, 18%); ophthalmic evaluation in
pts with systemic infection (15 pts, 17.04%); headaches (09 pts, 10.2%); ocular
pain (07 pts, 7.9%); red eye (09 pts, 10.2%); and others (08 pts, 09%). Fundus
examination was done in 82 pts (94.25%). 61 pts (74.39%) had normal findings
and 21 pts (25.6%) had some alteration. 15 pts (18.29%) had pathologic fundus
findings related to HIV infection. Of these 9 were asymptomatic and 6 were symptomatic. The final ophthalmologic diagnosis was: normal examination in 42 pts
(47.72%); ocular alterations not related to HIV in 30 pts (34%); ocular alterations
related to HIV in 16 pts (18.18%). Of the latter 7 pts had AIDS Retinopathy, 6
cytomegalovirus retinitis (CMV-R), 1 retinal toxoplasmosis (TOX), 1 papillitis and
1 lagophthalmos. Treatment was carried out in 17 pts with alterations not related
to HIV and in 4 pts with alterations related to HIV (ganciclovir in 3 pts and external
palpebral weight in 1).
Conclusions: The incidence of direct ocular compromise by HIV and of opportunistic ocular infections is comparatively low in this sample. Nevertheless,
ophthalmic screening examination must be included in routine evaluation of these
pts since there are diseases that may have an asymptomatic course but that
should be treated, such as CMV-R and TOX, in order to improve quality of life.
Also, and as part of a global medical assistance we will be able to treat general
ocular alterations that affect people with HIV as well as general population.
|32241 | Transient self-resolving CMV viremia in responders to
highly active antiretroviral therapy (HAART)

Romualdo Mazzi, Lanzafame Massimiliano, M. Trevenzoli, S. Pizzighella, P. del
Bravo, G. di Perri, E. Concia. Div Infectious Disease Univ. of Verona, Cattedra
Malatte Infettive Ospedale Civile Maggiore 37126 Verona, Italy
Objective: To monitor CMV antigenemia and CMV growth from blood cultures
in AIDS patients with prior episodes of CMV retinitis who interrupted anti-CMV
maintenance therapy following the successful initiation of HAART.

Design: Prospective, open study.
Methods: Monthly determinations of CMV antigenemia (CMV pp65) and blood
cultures for CMV were carried out in 7 HAART recipients with prior episodes of
CMV retinitis who interrupted anti-CMV maintenance therapy when their CD4+
cell counts increased to values >80/ul. Ophthalmoscopy was performed every
two weeks.
Results: Mean follow-up was 62 weeks (44-86). All subjects had negative
CMV antigenemia and blood cultures at interruption of anti-CMV maintenance
therapy. No reactivation of retinal disease was detected. In 5 subjects CMV
antigenemia and blood cultures remained persistently negative. In 2 patients a
low-grade rise of CMV antigenemia (<200 infected WBC/106) with positive blood
cultures were seen 8 and 10 months respectively after interruption of anti-CMV
treatment. In both cases these markers turned to negative within 4 weeks and remained unchanged in the following 6 months of surveillance without any anti-CMV
intervention.
Conclusions: In HAART responders, in the presence of a partially restored
immune function (CD4+ cell counts), transient low-grade rises of CMV antigenemia with concurrent positive blood cultures do not indicate a recurrence of CMV
retinitis.
132242 1 Uneventful interruption of anti-CMV maintenance therapy
in responders to highly active antiretroviral therapy
Giovanni di Perri1, M.R. Mazzi2, C.G. Carretta2, B.S. Bonora2, V.S. Vento2,
A.B. Allegranzi2, C.E. Concia2. 'Cattedra Malatte Infettive Ospedale Civile
Maggiore 37126 Verona; 2Univ. of Verona Verona, Italy
Objective: To determine whether the immunological recovery provided by highly
active antiretroviral therapy (HAART) in patients with AIDS and prior episodes
of CMV retinitis is protective against the otherwise rapid progression of retinal
damage which occurs without anti-CMV maintenance therapy.
Design: Prospective, open study.
Methods: Eight AIDS patients with prior episodes of CMV retinitis interrupted
anti-CMV maintenance therapy following the successful beginning of HAART
(with CD4+ cell counts increased to >80/ul). CD4+ cell counts and HIV-RNA
were monitored monthly while measurement of CMV antigenemia (CMV pp65)
and ophthalmoscopy were carried out every two weeks. 33 additional anti-CMV
antibody +ve patients with AIDS and no prior episodes of CMV retinitis who
started HAART in the same period were also prospectively studied.
Results: The 8 patients in whom anti-CMV maintenance therapy had been
interrupted did not show recurrence of retinitis during a mean follow-up of 52
weeks (32-74; SD 15). Among the HAART recipients with no prior episodes of
CMV retinitis the disease developed in 2 patients who had less than 50 CD4+
cells/ul and a positive CMV antigenemia at baseline and did not respond to
HAART.
Conclusions: Anti-CMV maintenance therapy can be interrupted with no subsequent progression of retinal damage in patients with AIDS who successfully
respond to HAART with a significant increase in CD4+ cell count.
1322431 Significance of CD4 cell count and HIV viral load on CMV
retinitis treated with an implant
Anne V. Fuchs1, E. Wolf2, A. Scheider1, A. Kampik1, H. Jager2. 1University Eye
Hospital, Mathildenstr 8 80336, Munich; 2Kis Curatorium for Immunedeficiency,
Munich, Germany
Background: Cytomegalovirus (CMV)-retinitis treated with a ganciclovir intraocular implant without additional systemic therapy shows prolonged non-progression
compared to systemic treatment. Although the ganciclovir storage exspires after
6-8 months we noted a relapse-free time up to 33 months. However, primarily
unilateral involved patients are at greater risk to develop retinitis contralateraly.
Objective: Since CMV retinitis hardly occurs in patients with high CD4 cell
counts and low HIV viral load (VL), the purpose was to evaluate the impact
of CD4 cell count and VL on retinitis relapse and contralateral or extraocular
manifestation in patients with ganciclovir devices.
Methods: Retrospectively CD4 cell counts and VL were evaluated in 20 patients with implants as maintenance therapy and no additional systemic treatment.
9 patients showed unilateral, 11 patients bilateral involvement.
Results: On implantation median CD4 cell count was 10/mm3, median VL 116
x 103 copies/mi. 2 patients relapsed after 6 and 12 months respectively, both
of them had a CD4 cell count of 10/mm3. In the nonprogression group median
CD4 cell counts were between 20/mm3 and 60/mm3 within this period of 6 to 12
months. There was no difference in VL (median: 45 x 103 vs. 44 x 103 copies/ml).
5 of 9 unilateral involved patients developed either bilateral disease (4 patients)
or extraocular disease (1 patient) after a median of 1.9 months. There was no
difference between patients with and without other manifestation concerning CD4
cell counts within the first two months. However, there was a significant difference
in VL at the time of pellet implantation. (426 x 103 vs 71 x 103 copies/mi).
Conclusion: There was no difference in CD4 cell counts or VL comparing
patients with and without retinitis relapse or occurance of other CMV manifes
tations in our study population. High VL at the time of implantation seems to
be a possible risk faktor for contralateral or extraocular involvement. Prolonged
relapse-free time more than 6 months after implant insertion cannot be explained
by a high CD4 cell count nor by low VL.