didanosine and Cytomegalovirus-Retinitis

While in the past human cytomegalovirus (HCMV) represented the major viral opportunistic pathogen in patients with AIDS, incidence of HCMV disease in HIV-infected patients drastically dropped after introduction of highly active antiretroviral therapy (HAART). However, cases of HCMV disease in HIV-infected patients treated with HAART have been reported.. A 38-year-old HIV-infected patient developed HCMV retinitis in May 1999 after reaching a nadir of 69 CD4(+) T cells/microl. HAART and anti-HCMV treatments with parenteral ganciclovir (GCV) were started, resulting in HIV viremia suppression, rise in CD4(+) T cell count to >300 cells/microl and recovery from retinitis. Notwithstanding the apparent immune reconstitution, every attempt to discontinue GCV maintenance treatment was followed by a relapse of retinal lesions. Thus, HCMV-specific CD4(+) cellular immune response was investigated.. Lymphoproliferation assay and cytokine flow cytometry analysis were performed repeatedly from November 1999 showing absolute lack of HCMV specific CD4(+) T cell response, in the presence of an efficient lymphoprolipherative response against another pathogen (Candida) or a mitogen (Phytohemoagglutinin).. In some patients, immune reconstitution after HAART may be only partial, since lack of pathogen-specific CD4(+) T cell response may persist even in the case of a significant rise in the absolute CD4(+) T cell count. This case suggests that immunologic assays investigating specific immune response against HCMV in HIV infected patients may be more useful than the CD4(+) T cell count alone in assessing immune function reconstitution after HAART and in deciding interruption of anti-HCMV secondary prophylaxis.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Antiviral Agents; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Cytomegalovirus Retinitis; Didanosine; Follow-Up Studies; Ganciclovir; HIV Protease Inhibitors; Humans; Lamivudine; Lymphocyte Activation; Male; Nevirapine; Recurrence; Reverse Transcriptase Inhibitors; Stavudine; Zidovudine

An HIV infected patient with cytomegalovirus retinitis with a CD4 lymphocyte count of 498 cells/mm3 after a good response to highly active antiretroviral therapy is described.. Some aspects of the immune system after highly active antiretroviral therapy remain unknown. CD4 T lymphocyte count might not be a good marker to identify some patients at risk of developing cytomegalovirus retinitis after this therapy.

Topics: Adult; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Antiviral Agents; CD4 Lymphocyte Count; Cytomegalovirus Retinitis; Didanosine; Ganciclovir; HIV Infections; HIV Protease Inhibitors; Humans; Lamivudine; Male; Retinal Hemorrhage; Reverse Transcriptase Inhibitors; Risk; Saquinavir; Stavudine; Substance Abuse, Intravenous; Zidovudine

Topics: Adolescent; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Antiviral Agents; CD4 Lymphocyte Count; Cytomegalovirus Retinitis; Didanosine; Ganciclovir; HIV Infections; Humans; Rifabutin; Uveitis; Visual Acuity