Causes of Visual Acuity Loss among HIV-infected Patients with Cytomegalovirus Retinitis in the Era of Highly Active Antiretroviral Therapy in Chiang Mai University Hospital
Chulaluck Tangmonkongvoragul MD*, Somsanguan Ausayakhun MD*
Affiliation : *Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Objective : To quantify the frequencies of the common causes of visual acuity loss for HIV-infected patients with cytomegalovirus
retinitis (CMVR) in the era of highly active antiretroviral therapy(HAART).
Material and Method: The present prospective observational study comprised 113 patients (184 eyes) with newly diagnosed
CMVR, from May 2008-March 2010. Each patient was followed-up every 3 months with medical history and ophthalmologic
examination. Patients were divided as visual impairment and legal blindness.
Results : The majority of the patients were native Thai (91%), while the rest was of hill tribe origin. 55% were females with age
ranged between 14 - 57 years (average of 39). The main cause of HIV infection was heterosexual contact (90%), followed by
homosexual contact (7%). It was found that 68% had CD4 T-cell count less than 50 cells/μl and that 46% had bilateral
CMVR. Major causes of visual impairment were CMVR zone 2&3, CMVR zone 1 and cataract, respectively. Major causes of
legal blindness were CMVR zone 2&3, CMVR zone 1 and retinal detachment, respectively. Retinal detachment was a major
risk factor in both groups. Even when surgery was successful, the visual acuity was not significantly improved, indicating a
permanent loss of vision.
Conclusion : In the HAART era, immune recovery of HIV patients also helps restoring specific anti-CMV immunity. HAART
reduces occurrence of visual impairment to 0.10/eye-year(EY) and legal blindness to 0.15/EY, compared to the pre-HAART
figures of 0.94-0.98/EY and 0.47-0.49/EY, respectively. However, it did not completely eliminate the occurrence. CMVR and
cataract remain the most common causes of visual acuity loss followed by retinitis-related retinal detachment, and optic nerve
atrophy respectively.
Keywords : Cytomegalovirus retinitis (CMVR), Visual acuity loss, Highly active antiretroviral therapy (HAART)
