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Treatment of AIDS-related cytomegalovirus retinitis

Authors
Mark A Jacobson, MD
David Heiden, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Jennifer Mitty, MD, MPH

INTRODUCTION

AIDS-related cytomegalovirus (CMV) retinitis is one of the most serious ocular complications in individuals with AIDS, which can progress to blindness, and in some cases, be accompanied by potentially fatal systemic disease. It is typically caused by reactivation of latent disease. CMV retinitis can be prevented by initiating antiretroviral therapy (ART) early in the course of HIV infection. However, CMV retinitis is still seen in patients who do not have access to these medications and/or are unable to adhere to their ART regimen.

The treatment of CMV retinitis will be reviewed here. The epidemiology, clinical manifestations, and diagnosis of CMV retinitis are discussed elsewhere. (See "Pathogenesis, clinical manifestations, and diagnosis of AIDS-related cytomegalovirus retinitis".)

APPROACH TO TREATMENT

For patients who develop AIDS-related cytomegalovirus (CMV) retinitis, treatment consists of CMV antiviral therapy and antiretroviral therapy (ART) for HIV. In high-income settings, we suggest starting ART approximately two weeks after starting therapy to treat cytomegalovirus (CMV) [1]. However, in resource-limited settings, ART should be initiated immediately. (See 'When to initiate antiretroviral therapy' below and 'Treatment in resource-limited settings' below.)

Antiviral treatment options for CMV retinitis include systemic and/or intravitreal therapy. Our approach to treatment is consistent with guideline recommendations [1] (table 1):

For patients with newly diagnosed infection, we first assess the location of the lesions (central versus peripheral) and if the patient has immediate sight-threatening disease (lesions <1500 microns from the fovea or adjacent to the optic nerve head).

                      

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Literature review current through: Nov 2016. | This topic last updated: Mon Jan 04 00:00:00 GMT+00:00 2016.
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