The prognosis of CMV retinitis among patients with AIDS in Serbia

Background: Cytomegalovirus (CMV) end-organ diseases, including CMV retinitis, are major opportunistic events in terminal AIDS patients. Methods: A retrospective study of 30 AIDS patients with CMV retinitis treated between 1997 and 2007 in Serbia was conducted to examine the prognosis and factors associated with survival. Results: Eighteen (60%) patients survived the mean follow-up period of 46.4 +/- 36 months. Patients' sex, mode of HIV transmission or previous AIDS diagnosis did not affect survival. Bilateral CMV retinitis predicted dissemination of CMV disease and poor prognosis (OR 7.8, 95% Cl 1.3-47.0, P = 0.012), but was not associated with blindness (P = 0.33). Among patients treated with HAART and CMV therapy the probability of surviving 10 years was 70%, while in those on CMV therapy alone, the median survival was 10 months (log rank P = 0.00). However, HAART itself was not sufficient to prevent blindness and the major predictor of blindness was a baseline CD4 cell count of less than 50/mu L (OR 6.8, 95% Cl 1.1-41.8, P = 0.03). After CMV disease, most patients suffered other opportunistic events regardless of HAART introduction. Conclusion: Even in the HAART era patients with advanced immunodeficiency and CMV retinitis may not escape from the high risk mortality group, while survivors commonly lose sight. (C) 2007 Elsevier Masson SAS. All rights reserved.