Cytomegalovirus retinitis in hospitalized people living with HIV in the late antiretroviral therapy era in Sao Paulo, Brazil

Background There is scarce information on AIDS-related cytomegalovirus (CMV) retinitis in middle-income countries. The objectives of this study were to identify the prevalence of active CMV retinitis in severely immunosuppressed people living with HIV (PLWHIV) and to describe its main features. Methods This retrospective cohort study was carried out at a tertiary center in Sao Paulo, Brazil. We included hospitalized adults PLWHIV with CD4 count <= 100 cells/mu L, >= one quantitation of CMV DNA in plasma, and indirect ophthalmoscopy evaluation. Results Thirty-eight (21.6%) of 176 participants had at least an ophthalmoscopy diagnosis and only 3 (1.7%) individuals presented active CMV retinitis. All these participants were male, and retinitis was asymptomatic in 2 cases. Two participants had extraocular end-organ CMV disease and detectable CMV DNA in plasma. Conclusions These results show a low prevalence of active CMV retinitis in the evaluated population. However, 2 of 3 participants had asymptomatic active CMV retinitis and a fifth of participants had at least one ophthalmoscopy diagnosis, suggesting the need for routine ophthalmologic evaluation in hospitalized severely immunosuppressed PLWHIV. The profile of participants with active CMV retinitis was similar to that described in the pre-ART era and quantitation of CMV DNA in plasma was variable.