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Retinal detachment in HIV-infected patients with cytomegalovirus retinitis treated with intravitreal ganciclovir

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Posterboard#: A0456

Abstract Number: 3957 - A0456

AuthorBlock: Louisa Lu1,6, Somsanguan Ausayakuhn2, Gary N. Holland3, Todd Margolis4, David Heiden5, Sakarin Ausayakuhn2, Jeremy Keenan6
1Yale School of Medicine, New Haven, Connecticut, United States; 2Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 3Department of Ophthalmology, Ocular Inflammatory Disease Center, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, United States; 4Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, United States; 5Department of Ophthalmology, Pacific Vision Foundation, California Pacific Medical Center, California, United States; 6Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States;

DisclosureBlock: Louisa Lu, None; Somsanguan Ausayakuhn, None; Gary N. Holland, None; Todd Margolis, None; David Heiden, None; Sakarin Ausayakuhn, None; Jeremy Keenan, None;

Purpose
The purpose of this study was to report the incidence of, and to estimate the risk factors associated with, the development of retinal detachment in a cohort of HIV-infected patients with cytomegalovirus (CMV) retinitis receiving treatment with intravitreal ganciclovir.

Methods
This prospective cohort study included HIV-infected patients with cytomegalovirus retinitis who presented to the ophthalmology clinic at Maharaj Nakorn Hospital in Chiang Mai, Thailand between May 2013 and March 2016. Patients with cytomegalovirus retinitis underwent dilated fundus examinations and received treatment with intravitreal ganciclovir according to a standardized schedule for 12 months. The incidence of new-onset retinal detachment was assessed and baseline risk factors for retinal detachment were analyzed using a Cox proportional hazards model, adjusted for the patient’s CD4 count and treatment with highly-active antiretroviral therapy (HAART).

Results
A total of 152 HIV-infected patients were included in the cohort study with a median duration of follow-up of 364 days (IQR: 217 to 399). Of 107 eyes without a retinal detachment at baseline, 13 developed a retinal detachment over the follow-up period (incidence 1.9 per 100 person-months, 95% CI 1.0-3.2). Cox proportional hazards models revealed no statistically significant relationship between the development of retinal detachment and any of the following baseline characteristics: age (HR 0.99 per year of age, 95% CI 0.93-1.06, P = 0.82); female sex (HR 1.08, 95% CI 0.35-3.36, P = 0.90); treatment with highly-active antiretroviral therapy (HAART) (HR 0.49, 95% CI 0.12-2.03, P = 0.33); or CD4 count of ≤ 50 (HR 1.25, 95% CI 0.99-1.01, P = 0.77.

Conclusions
The incidence of retinal detachment in this study cohort (1.9 per 100 person-months, or 0.23 per person-year) of HIV-infected patients with CMV retinitis receiving intravitreal ganciclovir is similar compared to that in the Longitudinal Study of Ocular Complications of AIDS (LSOCA) cohort. Although previous studies have reported that patients with CMV retinitis who were treated with HAART were less likely to develop retinal detachment, this analysis showed no significant association between treatment with HAART and development of retinal detachment.

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