Original Research

Cytomegalovirus retinitis and antiretroviral treatment: A fifteen year experience

Serisha Jay Narain, Linda Visser, Wilbert Sibanda
Southern African Journal of HIV Medicine | Vol 23, No 1 | a1322 | DOI: https://doi.org/10.4102/sajhivmed.v23i1.1322 | © 2022 Serisha Jay Narain, Linda Visser, Wilbert Sibanda | This work is licensed under CC Attribution 4.0
Submitted: 20 September 2021 | Published: 08 March 2022

About the author(s)

Serisha Jay Narain, Department of Ophthalmology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Linda Visser, Department of Ophthalmology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; and, Department of Ophthalmology, Faculty of Health Science, Stellenbosch University, Cape Town, South Africa
Wilbert Sibanda, Biostatistics Unit, Faculty of Health Sciences Management, Nelson Mandela University, Gqeberha, South Africa


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Abstract

Background: South Africa’s public antiretroviral treatment (ART) programme has undergone progressive changes since its introduction in 2004. The effect of this on the burden of the AIDS-defining opportunistic infection, cytomegalovirus retinitis (CMVR), in SA, has not been fully appreciated.

Objectives: To determine the effect of ART availability in the public sector of SA on the trend in the number of cases of newly diagnosed CMVR over time.

Methods: This is a retrospective study from 01 November 2002 to 31 August 2017 that took place at a tertiary hospital in the KwaZulu-Natal (KZN) province.

Results: A total of 383 participants were included in the study, with 60.1% being female and 94% of black African origin. The mean age of patients was 34.08 years (SD ± 7.24). A linear trend model suggested an overall linear decrease in the number of new cases of CMVR per year (R2 of 0.67). The average number of new cases of CMVR per year prior to ART being available to all persons living with HIV (PLWH) with a CD4+ ≤ 350 cells/μL and after was 34 and 13, respectively, and the difference (61.76%) between these values was statistically significant, P = 0.001. The median CD4+ count at diagnosis of CMVR was 22 (interquartile range: 9–51.25) cells/μL. An overall 51% of patients in this study were on ART at diagnosis of CMVR. There was a higher proportion of patients on ART ≤ 6 months (63.3%), compared with those on ART > 6 months (36.7%), and the difference was statistically significant, P < 0.01.

Conclusion: ART has resulted in a decrease in the burden of CMVR on ophthalmic services for many in KZN, particularly following the introduction of ART for all PLWH with a CD4 ≤ 350 cells/μL.


Keywords

cytomegalovirus retinitis; opportunistic infection; ocular; acquired immunodeficiency disease; human immunodeficiency virus; antiretroviral therapy

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