  
CMV prophylaxis can be safely stopped after response to HIV therapy
Last Updated: 2001-04-17 12:12:03 EDT (Reuters Health)
WESTPORT, CT (Reuters Health) - Cytomegalovirus (CMV) prophylactic maintenance therapy can be safely discontinued in HIV-infected patients with CMV retinitis whose CD4+ cell counts have increased to more than 150 cells/無 while on highly active antiretroviral therapy (HAART).
In a study reported in the April issue of the British Journal of Ophthalmology, Dr. Carlos Pavesio from Moorfields Eye Hospital in London and colleagues retrospectively analyzed the outcome of 41 HIV-infected patients with CMV retinitis who had discontinued anti-CMV maintenance therapy after showing a good response to HAART.
All of the subjects had initially been treated with intravenous ganciclovir. Overall, five patients had one CMV retinitis reactivation episode during maintenance that required retreatment with ganciclovir at induction levels.
The authors defined a good response to HAART as an increase in CD4+ cell counts to more than 100 cells/無 in one single test and an undetectable HIV viral load.
On average, patients were followed for 20.4 months after discontinuation of maintenance therapy, the researchers state. The lowest CD4+ cell count at the time of discontinuation was 143 cells/無 and only two patients had detectable viral loads. There was no evidence of CMV reactivation or progression in any subject.
The cutoff CD4+ levels were decided upon "around 3 years ago, at a time when nearly no data were available on this subject," the researchers note. "The level of 100 cells/無 was considered to be a reasonable level at that time, and until now there are no convincing data that lower levels are safe," they add.
Based on the current findings, Dr. Pavesio's team believes that a CD4+ level of 150 cells/無 is a more appropriate cutoff and that "close follow-up of these patients remains necessary, especially when CD4+ counts drop below this established level."
Br J Ophthalmol 2001;85:471-473.
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