Cytomegalovirus Retinitis (CMVR) in HIV-infected Pediatric Patients in Chiang Mai University Hospital Dao

Abstract

Background Cytomegalovirus retinitis (CMVR) is the most common opportunistic ocular infection in immunocompromised hosts. It affects many children in Thailand, but the data are limited for CMVR in Thai children.

Objectives To describe the signs, symptoms, ocular manifestations, visual acuity, T-lymphocyte CD4 level, treatment, complications of treatment and time to progression of CMVR in human immunodeficiency virus (HIV)-infected pediatric patients in Chiang Mai University Hospital.

Design Retrospective cohort study

Method The records of 36 HIV-infected pediatric patients, who had ophthalmic examinations between January 2002 and December 2012, were reviewed.

Results Of the 36 patients, 11 (14 eyes) had CMVR, 21 were normal and 4 (6 eyes) had other eye diseases. The average age (mean±SD) of the patients was 10.6±3.8 years and 9.5±3.6 years in the CMVR and normal group, respectively. The mean T-lymphocyte CD4 level was 23.7 cells/mm3 and 232.1 cells/mm3 in the CMVR and normal group, respectively. The mean log of minimum angle of resolution (MAR) in visual acuity was 1.27±1.1 and 0.11±0.1 in the CMVR and normal group, respectively. Patients receiving highly active antiretroviral therapy comprised 90.9% and 95% of the CMVR and normal group, respectively. Visual impairment was the most common presentation. Clinical manifestations showed opacification of the retina with areas of hemorrhage, exudate and necrosis, periphlebitis, frosted branch angiitis and vitritis.

Conclusions CMVR is associated with T-lymphocyte CD4 cells of <50 cells/mm3. Visual impairment is the most common presentation.