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Am J Ophthalmol. 2011 Oct;152(4):628-637.e1. doi: 10.1016/j.ajo.2011.04.007. Epub 2011 Jul 13.

Evaluation of the United States public health service guidelines for discontinuation of anticytomegalovirus therapy after immune recovery in patients with cytomegalovirus retinitis.

Collaborators (463)

Alan Lewis R, Bourg JM, Fainstein V, Krason Z, Morales JF, Orengo-Nania S, Samo TC, Spencer S, Weikert MP, Allen RC, Frady P, Gross R, Schmidt A, Shawver L, Shigley J, Slight B, Sotuyo R, Travers S, Srivastava SK, Gibbs A, Gibbs D, Jordan D, Myles B, Rutter J, Capone A Jr, Furukuwa D, Hubbard B, Martin DF, Goldman M, Brown J, Ciulla T, Craft J, Danis R, Fry P, Gao H, Gupta S, Hernandez J, Poe D, Pratt L, Richardson JD, Steffens T, Wheat LJ, Zwickl B, Dunn J, Brown DM, Cain D, Emmert D, Herring M, Jacobowitz A, Leder HA, Livingston AG, Morton Y, Nolan KD, Semba RD, Soto P, Thorne JE, Barditch-Crovo P, Bélair ML, Bolton SG, Brodine JB, Brune LM, Galor A, Jabs DA, Kapoor M, Kedhar SR, Kempen JH, Kim SJ, Oliver AL, Peters GB 3rd, Stevenson R, Tarver-Carr M, Wittenberg S, Wang MY, Bergsma D, Clark R, Cooper R, Elison J, Fuller B, Jarrott C, Otillio L, Reinoso M, Romero C, Barron B, Bye R, Conway M, Dillon L, Lombard A, Peyman G, Rescigno R, Bhagat N, Paez-Boham R, Paez-Quinde M, Heinemann MH, Coleman S, Daniel S, Janis R, Khanifer A, Kozbial A, Iglesias Rivera D, Sepkowitz K, Boyd K, Chan RV, Chiu C, Cole C, Doering C, Elison J, Lee S, Lu F, Murphy J, Pachydaki S, Peroni C, Rahhal FM, Reddy A, Warden S, Friedberg DN, Addessi A, Dieterich D, Lorenzo-Latkany M, Pei M, McMeeking A, Lyon AT, Ackatz L, Gill M, Kaminski L, Mirza R, Murphy R, Palella F, Ramirez C, Rozenbajgier Z, Ryan D, Simjanoski E, Habib A, Koecher J, Mathura J, Muñana A, Shankle J, Weinberg DV, Yuhr J, MacCumber MW, Gaynes B, Giannoulis C, Hulvey P, Kessler H, Khan HS, Kopp A, Merrill P, Morini F, Smith N, Tenorio A, Voskuil-Marre D, Woo K, Kuppermann BD, Alexandiescu B, Forthal DN, Grijalva J, Jehan F, Lopez K, Magallon R, Moinfar N, Trump B, Vega M, Williams R, Holland GN, Almanzor RD, Carlson ME, Castellanos JT, Craddock JA, Gonzales S, Johiro AK, Kalyani PS, Kapamajian MA, LeBeck DL, Lipka KM, Ransome SS, Chafey SA, Charonis AC, Kappel PJ, Moe AA, Piñón G, Sanderson A, Shah KH, Stalling R, Thayer D, Vaudaux JD, Freeman WR, Cochran D, Kozak I, Magana L, Morrison V, Nguyen V, Oster S, Chaidhawanqual S, Cheng L, Clark T, Cleveland M, Gannon RL, Garcia C, Goldberg D, Hedaya J, Karavellas M, Kemper T, Kosobucki B, Mask A, Reagan N, Song MK, Torriani F, Wong D, Young T, Duncan J, Ballesteros F Jr, Bhisitkul R, Brown D, Clay D, Deiner M, Eubank D, Jacobson M, Lew M, Margolis T, Aberg J, Hoffman J, Irvine A, Larson J, Lawrence J, Narahara M, Trinidad M, Meredith TA, Barnhart S, Cantrell D, Garg S, Hartnett E, Landers MB, Moyer S, Wohl D, Betran S, DeBoer K, Eifrig D, Foley J, Jeffries A, Kylstra J, Longmire B, Myers S, N'Dure F, Oh KT, Pantell J, Pedersen S, Rich C, Sotelo CA, van der Horst C, Wadhvania S, Nichols CW, Bardsley M, Devine CC, Kostman J, Maguire A, Nyberg W, Smith L, Helker C, MacGregor R, McGibney K, Mickelberg K, Lim JI, Bhatti R, Canzano J, Chang TS, Charonis A, Chong L, Equi R, Fawzi A, Flaxel C, Garcia J, Klesert T, Kramer F, Levin L, Nichols T, Pelzek C, Podilla M, Richine L, Romo D, Sadda S, Scartozzi R, See R, Shiramizu K, Thomas M, Walonker AF, Walsh A, Wu Z, Pavan PR, Leto J, Madow B, Oehler R, Patel N, Saxon W, Sherouse S, Burrows A, Carlton S, Goldstein B, Gompf S, Hernandez B, Iyer M, Kelty P, Kramer A, Millard S, Nadler J, Paulter SE, Tordilla-Wadia J, Walker N, Davis G, Blem R, Bourg JM, Horna J, Kelso C, Krason Z, Li HK, Nguyen LC, Nolen R, Onarato M, Paar D, Rivas S, Seitz V, Spillar H, Uwaydat S, Jabs DA, Hilal Y, Nieves M, Pascual K, Slutsky J, Stevens M, Southall JC, Meinert CL, Ahuja A, Amend-Libercci DA, Collins KL, Collison BJ, Colvin R, Dodge J, Donithan M, Ewing C, Frick K, Holbrook JT, Isaacson MR, Jackson RM, Livingston H, McCaffrey L, Puhan M, Reyes G, Smith J, Smith M, Sugar E, Thorne JE, Tonascia JA, Van Natta ML, Wagoner A, Benham C, Colvin R, Foster G, Harle J, Gilpin AM, Kempen JH, Martin BK, Min N, Murrow L, Oziemkowska MJ, Ping Ng W, Scott PE, Smothers E, West E, Woo C, Wu A, Zong A, Danis R, Chandler C, Gangaputra S, Guilfoil G, Hubbard L, Joyce J, Pauli T, Robinson N, Thayer D, Pak JW, Zhang G, Altaweel M, Armstrong J, Davis MD, Glaeser S, Hughes K, Hurlburt D, Kastorff L, Neider M, Traut T, Vanderhoof-Young M, Wabers H, Kurinij N, Jabs DA, Danis R, Kurinij N, Meinert CL, Thorne JE, Davis MD, Holbrook JT, Jabs DA, Danis R, Dunn JP, Holland GN, Isaccson MR, Jacobson M, Kurinij N, Lewis R, Nolan KD, Meinert CL, Nyberg W, Palella F, Thorne JE, Addessi A, Brune L, Clark R, Clark T, Davis J, Davis MD, Freeman WR, Friedberg D, Gilman J, Holbrook JT, Horna J, Hubbard L, Jacobson M, Martin DF, Meredith TA, Muñana A, Murphy R, Reed Pavan P, Spencer S, Steffens T, Thayer D, van der Horst C, Wallach F, Phair JP, Conway BP, Davis BR, Jabs DA, Kurinij N, Meinert CL, Musch D, Nussenblatt RB, Thorne JE, Whitley R, Brown BW, Davis MD, Grizzle J, Hillis A, Holbrook JT, Smith H, Tonascia JA, Spencer S, Almanzor RD, Gibbs D, Isaacson M, Lew M, Lewis RA, Ballesteros F, Grijalva J, Lopez K, Neisser LG, Paez-Boham R.

Author information

1
Center for Clinical Trials, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21232, USA. jholbroo@jhsph.edu

Abstract

PURPOSE:

To evaluate United States Public Health Service (USPHS) guidelines for discontinuing anticytomegalovirus (CMV) therapy in patients with AIDS who have immune recovery and quiescent retinitis after initiating highly active antiretroviral therapy.

DESIGN:

Cohort study of patients with CMV retinitis (Longitudinal Study of Ocular Complications of AIDS).

METHODS:

Participants had CMV retinitis and CD4+ T-cell counts of 50 cells/μL or fewer enrolled from 1998 through 2009 who demonstrated sustained immune recovery (2 consecutive CD4+ T-cell counts of 100 cells/μL or more at least 6 months apart) and inactive retinitis. Participants were classified into 2 groups according to anti-CMV treatment after immune recover: (1) continued anti-CMV therapy and (2) discontinued therapy. We evaluated survival, visual acuity, and CMV retinitis activity; we used propensity scores to adjust for confounding factors for these analyses.

RESULTS:

Of 152 participants reviewed, 71 demonstrated immune recovery, 37 of whom discontinued therapy and 34 of whom continued therapy. At immune recovery, participants continuing therapy tended to be older (44 vs 40 years; P = .09), have bilateral retinitis (53% vs 32%; P = .10), and have lower CD4+ T-cell counts (148 vs 207 cells/μL; P < .001). There were no statistical differences in any of the clinical outcomes (death, retinitis progress, visual acuity, or incidence of bilateral retinitis). Both groups lost visual acuity during follow-up, on average 1.2 letters per year (P < .01).

CONCLUSIONS:

Discontinuation of anti-CMV therapy after immune recovery did not increase the risk of poor outcomes. These results support the current guidelines for discontinuation of anti-CMV therapy after achievement of sustained immune recovery.

PMID:
21742304
PMCID:
PMC3185165
DOI:
10.1016/j.ajo.2011.04.007
[Indexed for MEDLINE]
Free PMC Article

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