Clinical manifestations of the initial-stage cytomegalovirus retinitis in acquired immunodeficiency syndrome patients_Chinese Journal of Ocular Fundus Diseases

Authors：

Du Kuifang ¹ , Huang Xiaojie ² , Chen Chao ¹ , Kong Wenjun ¹ , Xie Lianyong ¹ ,  Wei Wenbin ³

1. Beijing Infectious Ophthalmopathy Center, Department of Ophthalmology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China;
2. Department of Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China;
3. Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing Infectious Eye Disease Diagnosis and Treatment Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China;

Corresponding author：

Wei Wenbin, Email: weiwenbintr@163.com

Keywords：

Acquired immunodeficiency syndrome; Cytomegalovirus retinitis; Initial stage

DOI：

10.3760/cma.j.cn511434-20200628-00308

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Objective To investigate the clinical manifestations of acquired immunodeficiency syndrome(AIDS) patients with initial-stage cytomegalovirus (CMV) retinitis (CMVR).Methods Retrospective case series study. From July 2017 to November 2019, 21 patients with 22 eyes of AIDS combined with CMVR in the initial stage of AIDS and CMVR diagnosed in the eye examination in the study. Among them, there were 19 males with 19 eyes and 2 females with 3 eyes; the average age was 34.3±9.6 years. The average CD4⁺ T lymphocyte count of patients was 26.1±23.2/μl. Routine fundus screening revealed 17 cases, and the contralateral eye disease was found in 4 cases. There were 13 cases of CMVR in both eyes (61.9%, 13/21). Among them, both eyes were in the initial stage of CMVR, and the contralateral eyes were in the early stage of CMVR in 12 cases. The contralateral eye included 2 cases of human immunodeficiency virus-related retinal microangiopathy, 1 case of optic disc edema, and 5 cases of no obvious abnormality on fundus examination. All patients underwent slit lamp microscopy and ultra-wide-angle fundus photography examination. At the same time, 18 eyes underwent optical coherence tomography (OCT). Blood CMV-DNA detection was performed in 17 cases within 1 week before the first diagnosis; aqueous CMV-DNA detection was performed in 7 eyes within 1 week after the first diagnosis. Within 1 week after the fundus examination, 8 eyes of 8 cases and 8 eyes of 7 cases were received and not received systemic anti-CMV treatment; the treatment status was unknown in 6 cases and 6 eyes. After treatment, 18 eyes of 17 cases were followed up. The follow-up time was 0.5-28 months.Results There were no obvious abnormalities in the anterior segment examination of all the affected eyes; the vitreous body was transparent. The fundus lesions were less than 1 optic disc diameter (DD), and they were white granular, clustered, with blurred edges. Among them, there were granular satellite lesions around the lesion in 18 eyes (81.8%, 18/22). The lesions were located in 19 eyes (86.4%, 19/22) in zone 2, 1 eye in zone 1 and 2 (4.5%, 1/22), and 2 eyes in zone 3 (9.1%, 2/22). In 18 eyes that underwent OCT examination, 12 eyes failed to obtain image data because the lesion was not in the conventional scanning range; the other 6 eyes showed the inner or full retina thickened or atrophy depression, structural destruction, accompanied by local vitreous punctate strong reflection. Among the 17 patients who underwent blood CMV-DNA testing, 1 (5.9%, 1/17) and 16 (94.1%, 16/17) cases were CMV-DNA negative and positive, respectively. The 7 eyes that underwent the CMV-DNA test of aqueous humor were all negative. Among the 18 eyes who were followed up, the lesions did not expand, and gradually subsided and absorbed in 4 eyes (22.2%, 4/18); the varying degrees of lesion enlargement in 14 eyes (77.8%, 14/18).Conclusion The patients with AIDS and CMVR at the initial stage have no obvious ocular symptoms; the fundus shows white granular lesions less than 1 DD with blurred edges.

Citation： Du Kuifang, Huang Xiaojie, Chen Chao, Kong Wenjun, Xie Lianyong, Wei Wenbin. Clinical manifestations of the initial-stage cytomegalovirus retinitis in acquired immunodeficiency syndrome patients. Chinese Journal of Ocular Fundus Diseases, 2021, 37(7): 513-517. doi: 10.3760/cma.j.cn511434-20200628-00308 Copy

1.	Agarwal A, Singh R, Sharma A, et al. Ocular manifestations in patients with human immunodeficiency virus infection in the pre-HAART versus the HAART era in the north Indian population[J]. Ocul Immunol Inflamm, 2017, 25(3): 396-404. DOI: 10.3109/09273948.2015.1133837.
2.	Munro M, Yadavalli T, Fonteh C, et al. Cytomegalovirus retinitis in HIV and non-HIV individuals[J/OL]. Microorganisms, 2019, 28, 8(1): 55[2019-12-28]. https://pubmed.ncbi.nlm.nih.gov/31905656/. DOI: 10.3390/microorganisms8010055.
3.	Yashiro S, Nishijima T, Yamamoto Y, et al. Spectral domain optical coherence tomography and fundus autofluorescence findings in cytomegalovirus retinitis in HIV-infected patients[J]. Jpn J Ophthalmol, 2018, 62(3): 373-389. DOI: 10.1007/s10384-018-0574-9.
4.	Ruiz-Cruz M, Alvarado-de la Barrera C, Ablanedo-Terrazas Y, et al. Proposed clinical case definition for cytomegalovirus-immune recovery retinitis[J]. Clin Infect Dis, 2014, 59(2): 298-303. DOI: 10.1093/cid/ciu291.
5.	AIDS Clinical Trials Group (ACTG). Studies of ocular complications of AIDS foscarnet-ganciclovir cytomegalovirus retinitis trial: 1. rationale, design, and methods[J]. Control Clin Trials, 1992, 13(1): 22-39. DOI: 10.1016/0197-2456(92)90027-w.
6.	Nagata Y, Obata H, Fujino Y, et al. Early cytomegalovirus retinitis[J]. Nippon Ganka Gakkai Zasshi, 1994, 98(11): 1147-1152.
7.	Ausayakhun S, Keenan JD, Ausayakhun S, et al. Clinical features of newly diagnosed cytomegalovirus retinitis in northern Thailand[J]. Am J Ophthalmol, 2012, 153(5): 923-931. DOI: 10.1016/j.ajo.2011.10.012.
8.	Jirawison C, Yen M, Leenasirimakul P, et al. Telemedicine screening for cytomegalovirus retinitis at the point of care for human immunodeficiency virus infection[J]. JAMA Ophthalmol, 2015, 133(2): 198-205. DOI: 10.1001/jamaophthalmol.2014.4766.
9.	Liscombe-Sepúlveda JP, Alba-Linero C, Llorenç-Belles V, et al. Utility of ultra-widefield retinal imaging in the follow-up and management of patients with cytomegalovirus retinitis[J]. Ocul Immunol Inflamm, 2019, 28(4): 659-664. DOI: 10.1080/09273948.2019.1606257.
10.	Wongchaisuwat N, Khongpipatchaisiri S, Boonsopon S, et al. Extralesional microvascular and structural macular abnormalities in cytomegalovirus retinitis[J/OL]. Sci Rep, 2020, 10(1): 21432[2020-12-08]. https://pubmed.ncbi.nlm.nih.gov/33293646/. DOI: 10.1038/s41598-020-78587-6.
11.	Smith IL, Christopher MJ, Freeman WR, et al. Cytomegalovirus (CMV) retinitis activity is accurately reflected by the presence and level of CMV DNA in aqueous humor and vitreous[J]. J Infect Dis, 1999, 179(5): 1249-1253. DOI: 10.1086/314710.
12.	Mao F, Sun H, Li D, et al. Polymerase chain reaction analysis of aqueous humor specimens in the diagnosis of cytomegalovirus retinitis in AIDS patients[J]. Eur J Ophthalmol, 2020, 30(4): 738-742. DOI: 10.1177/1120672119841777.
13.	Ando Y, Terao K, Narita M, et al. Quantitative analyses of cytomegalovirus genome in aqueous humor of patients with cytomegalovirus retinitis[J]. Jpn J Ophthalmol, 2002, 46(3): 254-260. DOI: 10.1016/s0021-5155(01)00524-x.
14.	Mizushima D, Nishijima T, Yashiro S, et al. Diagnostic utility of quantitative plasma cytomegalovirus DNA PCR for cytomegalovirus end-organ diseases in patients with HIV-1 infection[J]. J Acquir Immune Defic Syndr, 2015, 68(2): 140-146. DOI: 10.1097/QAI.0000000000000410.
15.	Griffiths P, Baraniak I, Reeves M. The pathogenesis of human cytomegalovirus[J]. J Pathol, 2015, 235(2): 288-297. DOI: 10.1002/path.4437.
16.	Carstensen S, Raboni SM, França JCB, et al. Standardization of antigenemia and qPCR cut-off values in whole blood for the detection of cytomegalovirus disease in HIV patients[J/OL]. Rev Soc Bras Med Trop, 2019, 52: e20180457[2019-06-27]. https://pubmed.ncbi.nlm.nih.gov/31271616/. DOI: 10.1590/0037-8682-0457-2018.
17.	El Amari EB, Combescure C, Yerly S, et al. Clinical relevance of cytomegalovirus viraemia[J]. HIV Med, 2011, 12(7): 394-402. DOI: 10.1111/j.1468-1293.2010.00900.x.
18.	Tan BH. Cytomegalovirus treatment[J]. Curr Treat Options Infect Dis, 2014, 6(3): 256-270. DOI: 10.1007/s40506-014-0021-5.
19.	Jabs DA, Van Natta ML, Holland GN, et al. Cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome after initiating antiretroviral therapy[J]. Am J Ophthalmol, 2017, 174: 23-32. DOI: 10.1016/j.ajo.2016.10.011.

1. Agarwal A, Singh R, Sharma A, et al. Ocular manifestations in patients with human immunodeficiency virus infection in the pre-HAART versus the HAART era in the north Indian population[J]. Ocul Immunol Inflamm, 2017, 25(3): 396-404. DOI: 10.3109/09273948.2015.1133837.
2. Munro M, Yadavalli T, Fonteh C, et al. Cytomegalovirus retinitis in HIV and non-HIV individuals[J/OL]. Microorganisms, 2019, 28, 8(1): 55[2019-12-28]. https://pubmed.ncbi.nlm.nih.gov/31905656/. DOI: 10.3390/microorganisms8010055.
3. Yashiro S, Nishijima T, Yamamoto Y, et al. Spectral domain optical coherence tomography and fundus autofluorescence findings in cytomegalovirus retinitis in HIV-infected patients[J]. Jpn J Ophthalmol, 2018, 62(3): 373-389. DOI: 10.1007/s10384-018-0574-9.
4. Ruiz-Cruz M, Alvarado-de la Barrera C, Ablanedo-Terrazas Y, et al. Proposed clinical case definition for cytomegalovirus-immune recovery retinitis[J]. Clin Infect Dis, 2014, 59(2): 298-303. DOI: 10.1093/cid/ciu291.
5. AIDS Clinical Trials Group (ACTG). Studies of ocular complications of AIDS foscarnet-ganciclovir cytomegalovirus retinitis trial: 1. rationale, design, and methods[J]. Control Clin Trials, 1992, 13(1): 22-39. DOI: 10.1016/0197-2456(92)90027-w.
6. Nagata Y, Obata H, Fujino Y, et al. Early cytomegalovirus retinitis[J]. Nippon Ganka Gakkai Zasshi, 1994, 98(11): 1147-1152.
7. Ausayakhun S, Keenan JD, Ausayakhun S, et al. Clinical features of newly diagnosed cytomegalovirus retinitis in northern Thailand[J]. Am J Ophthalmol, 2012, 153(5): 923-931. DOI: 10.1016/j.ajo.2011.10.012.
8. Jirawison C, Yen M, Leenasirimakul P, et al. Telemedicine screening for cytomegalovirus retinitis at the point of care for human immunodeficiency virus infection[J]. JAMA Ophthalmol, 2015, 133(2): 198-205. DOI: 10.1001/jamaophthalmol.2014.4766.
9. Liscombe-Sepúlveda JP, Alba-Linero C, Llorenç-Belles V, et al. Utility of ultra-widefield retinal imaging in the follow-up and management of patients with cytomegalovirus retinitis[J]. Ocul Immunol Inflamm, 2019, 28(4): 659-664. DOI: 10.1080/09273948.2019.1606257.
10. Wongchaisuwat N, Khongpipatchaisiri S, Boonsopon S, et al. Extralesional microvascular and structural macular abnormalities in cytomegalovirus retinitis[J/OL]. Sci Rep, 2020, 10(1): 21432[2020-12-08]. https://pubmed.ncbi.nlm.nih.gov/33293646/. DOI: 10.1038/s41598-020-78587-6.
11. Smith IL, Christopher MJ, Freeman WR, et al. Cytomegalovirus (CMV) retinitis activity is accurately reflected by the presence and level of CMV DNA in aqueous humor and vitreous[J]. J Infect Dis, 1999, 179(5): 1249-1253. DOI: 10.1086/314710.
12. Mao F, Sun H, Li D, et al. Polymerase chain reaction analysis of aqueous humor specimens in the diagnosis of cytomegalovirus retinitis in AIDS patients[J]. Eur J Ophthalmol, 2020, 30(4): 738-742. DOI: 10.1177/1120672119841777.
13. Ando Y, Terao K, Narita M, et al. Quantitative analyses of cytomegalovirus genome in aqueous humor of patients with cytomegalovirus retinitis[J]. Jpn J Ophthalmol, 2002, 46(3): 254-260. DOI: 10.1016/s0021-5155(01)00524-x.
14. Mizushima D, Nishijima T, Yashiro S, et al. Diagnostic utility of quantitative plasma cytomegalovirus DNA PCR for cytomegalovirus end-organ diseases in patients with HIV-1 infection[J]. J Acquir Immune Defic Syndr, 2015, 68(2): 140-146. DOI: 10.1097/QAI.0000000000000410.
15. Griffiths P, Baraniak I, Reeves M. The pathogenesis of human cytomegalovirus[J]. J Pathol, 2015, 235(2): 288-297. DOI: 10.1002/path.4437.
16. Carstensen S, Raboni SM, França JCB, et al. Standardization of antigenemia and qPCR cut-off values in whole blood for the detection of cytomegalovirus disease in HIV patients[J/OL]. Rev Soc Bras Med Trop, 2019, 52: e20180457[2019-06-27]. https://pubmed.ncbi.nlm.nih.gov/31271616/. DOI: 10.1590/0037-8682-0457-2018.
17. El Amari EB, Combescure C, Yerly S, et al. Clinical relevance of cytomegalovirus viraemia[J]. HIV Med, 2011, 12(7): 394-402. DOI: 10.1111/j.1468-1293.2010.00900.x.
18. Tan BH. Cytomegalovirus treatment[J]. Curr Treat Options Infect Dis, 2014, 6(3): 256-270. DOI: 10.1007/s40506-014-0021-5.
19. Jabs DA, Van Natta ML, Holland GN, et al. Cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome after initiating antiretroviral therapy[J]. Am J Ophthalmol, 2017, 174: 23-32. DOI: 10.1016/j.ajo.2016.10.011.

Chinese Journal of Ocular Fundus Diseases

Clinical manifestations of the initial-stage cytomegalovirus retinitis in acquired immunodeficiency syndrome patients

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