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Regression of Cytomegalovirus Retinitis With Zidovudine: A Clinicopathologic Correlation

Regression of Cytomegalovirus Retinitis With Zidovudine: A Clinicopathologic Correlation Abstract • A 55-year-old man with the acquired immunodeficiency syndrome had cytomegalovirus (CMV) retinitis develop in his left eye. The patient declined treatment with ganciclovir but elected to be treated with zidovudine. Two months later his CMV retinitis regressed, and it remained inactive for a total of 9 months. The most likely explanation was zidovudine-mediated improvement in the patient's immune function with subsequent suppression of the CMV retinitis in the left eye. The patient ultimately and preterminally had CMV retinitis develop in his right eye. He subsequently died and his eyes were examined at autopsy. Active CMV retinitis lesions were noted in the right eye while inactive scars were noted in the left eye. Immunoperoxidase staining and in situ hybridization studies demonstrated the presence of CMV in the right eye but not in the left eye. While ganciclovir remains the treatment of choice for CMV retinitis, zidovudine treatment may have a beneficial effect on CMV retinitis in some patients. References 1. Holland GN, Gottlieb MS, Yee RD, Schanter HM, Pettit TH. Ocular disorders associated with a new severe acquired cellular immunodeficiency syndrome . Am J Ophthalmol . 1982;93:393-402. 2. Rosenberg PR, Uliss AE, Friedland GH, Harris CA, Small CB, Klein RS. Acquired immune deficiency syndrome: ophthalmic manifestations in ambulatory patients . Ophthalmology . 1983;90:874-878.Crossref 3. Holland GN, Pepose JS, Pettit TH, Gottlieb MS, Yee RD, Foos RY. Acquired immune deficiency syndrome: ocular manifestations . Ophthalmology . 1983;90:859-873.Crossref 4. Newman NM, Mandel MR, Gullett J, Fujikawa L. Clinical and histologic findings in opportunistic ocular infections: part of a new syndrome of acquired immunodeficiency . Arch Ophthalmol . 1983;101:396-401.Crossref 5. Khadem M, Kalish SB, Goldsmith JA, et al. Ophthalmologic findings in acquired immune deficiency syndrome (AIDS) . Arch Ophthalmol . 1984;102:201-206.Crossref 6. Newsome DA, Green WR, Miller ED, et al. Microvascular aspects of acquired immune deficiency syndrome retinopathy . Am J Ophthalmol . 1984;98:590-601. 7. Freeeman WR, Lerner CW, Mines JA, et al. A prospective study of the ophthalmologic findings in the acquired immune deficiency syndrome . Am J Ophthalmol . 1984;97:133-142. 8. Pepose JS, Holland GN, Nestor MS, Cochran AJ, Foos RY. Acquired immune deficiency syndrome: pathogenic mechanisms of ocular disease . Ophthalmology . 1985;92:472-484.Crossref 9. Egbert PR, Pollard RB, Gallagher JG, Merigan TC. Cytomegalovirus retinitis in immunosuppressed hosts, II: ocular manifestations . Ann Intern Med . 1980;93:664-670.Crossref 10. Bach MC, Bagwell SP, Knapp NP, et al. 9-(1,3-dihydroxy-2-propoxymethyl) guanine for cytomegalovirus infections in patients with the acquired immunodeficiency syndrome . Ann Intern Med . 1985;103:381-382.Crossref 11. Palestine AG, Stevens G Jr, Lane HC, et al. Treatment of cytomegalovirus retinitis with dihydroxy propoxymethyl guanine . Am J Ophthalmol . 1986;101:95-101. 12. Collaborative DHPG Treatment Study Group. Treatment of serious cytomegalovirus infections with 9-(1,3-dihydroxy-2-propoxymethyl) guanine in patients with AIDS and other immunodeficiencies . N Engl J Med . 1986;314:801-805.Crossref 13. Rosecan LR, Stahl-Bayliss CM, Kalman CM, Laskin OL. Antiviral therapy for cytomegalovirus retinitis in AIDS with dihydroxy propoxymethyl guanine . Am J Ophthalmol . 1986;101:405-418. 14. Jabs DA, Wingard JR, de Bustros S, de Miranda P, Saval R, Santos GW. BW B759U for cytomegalovirus retinitis: intraocular drug penetration . Arch Ophthalmol . 1986;104:1436-1437.Crossref 15. D'Amico DJ, Talamo JH, Felsenstein D, Hirsch MS, Albert DM, Schooley RJ. Ophthalmoscopic and histologic findings in cytomegalovirus retinitis treated with BW-B759U . Arch Ophthalmol . 1986;104:1788-1793.Crossref 16. Henderly DR, Freeman WR, Causey DM, Rao NA. Cytomegalovirus retinitis with response to therapy with ganciclovir . Ophthalmology . 1987;94;425-434. 17. Holland GN, Sidikaru Y, Kreiger AE, et al. Treatment of cytomegalovirus retinopathy with ganciclovir . Ophthalmology . 1987;94:815-823.Crossref 18. Jabs DA, Newman C, de Bustros S, Polk BF. Treatment of cytomegalovirus retinitis with ganciclovir . Ophthalmology . 1987;94:824-830.Crossref 19. Orellana J, Teich SA, Friedman AH, Lerebours F, Winterkorn J, Mildram D. Combined short- and long-term therapy for the treatment of cytomegalovirus retinitis using ganciclovir (BW B759U) . Ophthalmology . 1987;94:831-838.Crossref 20. Henry K, Cantrill H, Fletcher C, Chinnock BJ, Balfour HH. Use of intravitreal ganciclovir (dihydroxy propoxymethyl guanine) for cytomegalovirus retinitis in a patient with AIDS . Am J Ophthalmol . 1987;103:17-23. 21. Fischl MA, Richman DD, Grieco MH, et al. The efficacy of 3′-azido-3′-deoxythymidine (azidothymidine) in the treatment of patients with AIDS and AIDS-related complex: a double-blind placebo-controlled trial . N Engl J Med . 1987;317:185-191.Crossref 22. Brigati DJ, Myerson D, Learry JJ, et al. Detection of viral genomes in cultured cells and paraffin-embedded tissue sections using biotinlabeled hybridization probes . Virology . 1983;126:32-50.Crossref 23. Unger ER, Budgeon LR, Myerson D, et al. Viral diagnosis by in situ hybridization: description of a rapid simplified colorimetric method . Am J Surg Pathol . 1986;10:1-8.Crossref 24. Hsu SM, Raine L, Fanger H. Use of avidinbiotin-peroxidase complex (ABC) in immunoperoxidase techniques: a comparison between ABC and unlabelled antibody (PAP) procedures . J Histochem Cytochem . 1981;29:577.Crossref 25. Richman DD, Fischl MA, Grieco MH, et al. The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: a double-blind, placebo-controlled trial . N Engl J Med . 1987;317:192-197.Crossref 26. Pomerantz RJ, Kuritzkes DR, De la Monte SM, et al. Infection of the retina by human immunodeficiency virus type I . N Engl J Med . 1987;317:1643-1647.Crossref 27. Skolnick PR, Kosloff BR, Hirsch MS. Bidirectional interactions between human immunodeficiency virus type 1 (HIV-1) and cytomegalovirus . J Infect Dis . 1988;157:508-514.Crossref 28. Fay MT, Freeman WR, Wiley CA, Hardy D, Bozzette S. Atypical retinitis in patients with the acquired immunodeficiency syndrome . Am J Ophthalmol . 1988;105:483-490. 29. D'Amico DJ, Skolnick PR, Kosloff BR, et al. Resolution of cytomegalovirus with zidovudine therapy . Arch Ophthalmol . 1988;106:1168-1169.Crossref 30. Jabs DA, Enger C, Bartlett JD. Cytomegalovirus retinitis and acquired immunodeficiency syndrome . Arch Ophthalmol . 1989;107:75-80.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Regression of Cytomegalovirus Retinitis With Zidovudine: A Clinicopathologic Correlation

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References (33)

Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1989.01070010890037
Publisher site
See Article on Publisher Site

Abstract

Abstract • A 55-year-old man with the acquired immunodeficiency syndrome had cytomegalovirus (CMV) retinitis develop in his left eye. The patient declined treatment with ganciclovir but elected to be treated with zidovudine. Two months later his CMV retinitis regressed, and it remained inactive for a total of 9 months. The most likely explanation was zidovudine-mediated improvement in the patient's immune function with subsequent suppression of the CMV retinitis in the left eye. The patient ultimately and preterminally had CMV retinitis develop in his right eye. He subsequently died and his eyes were examined at autopsy. Active CMV retinitis lesions were noted in the right eye while inactive scars were noted in the left eye. Immunoperoxidase staining and in situ hybridization studies demonstrated the presence of CMV in the right eye but not in the left eye. While ganciclovir remains the treatment of choice for CMV retinitis, zidovudine treatment may have a beneficial effect on CMV retinitis in some patients. References 1. Holland GN, Gottlieb MS, Yee RD, Schanter HM, Pettit TH. Ocular disorders associated with a new severe acquired cellular immunodeficiency syndrome . Am J Ophthalmol . 1982;93:393-402. 2. Rosenberg PR, Uliss AE, Friedland GH, Harris CA, Small CB, Klein RS. Acquired immune deficiency syndrome: ophthalmic manifestations in ambulatory patients . Ophthalmology . 1983;90:874-878.Crossref 3. Holland GN, Pepose JS, Pettit TH, Gottlieb MS, Yee RD, Foos RY. Acquired immune deficiency syndrome: ocular manifestations . Ophthalmology . 1983;90:859-873.Crossref 4. Newman NM, Mandel MR, Gullett J, Fujikawa L. Clinical and histologic findings in opportunistic ocular infections: part of a new syndrome of acquired immunodeficiency . Arch Ophthalmol . 1983;101:396-401.Crossref 5. Khadem M, Kalish SB, Goldsmith JA, et al. Ophthalmologic findings in acquired immune deficiency syndrome (AIDS) . Arch Ophthalmol . 1984;102:201-206.Crossref 6. Newsome DA, Green WR, Miller ED, et al. Microvascular aspects of acquired immune deficiency syndrome retinopathy . Am J Ophthalmol . 1984;98:590-601. 7. Freeeman WR, Lerner CW, Mines JA, et al. A prospective study of the ophthalmologic findings in the acquired immune deficiency syndrome . Am J Ophthalmol . 1984;97:133-142. 8. Pepose JS, Holland GN, Nestor MS, Cochran AJ, Foos RY. Acquired immune deficiency syndrome: pathogenic mechanisms of ocular disease . Ophthalmology . 1985;92:472-484.Crossref 9. Egbert PR, Pollard RB, Gallagher JG, Merigan TC. Cytomegalovirus retinitis in immunosuppressed hosts, II: ocular manifestations . Ann Intern Med . 1980;93:664-670.Crossref 10. Bach MC, Bagwell SP, Knapp NP, et al. 9-(1,3-dihydroxy-2-propoxymethyl) guanine for cytomegalovirus infections in patients with the acquired immunodeficiency syndrome . Ann Intern Med . 1985;103:381-382.Crossref 11. Palestine AG, Stevens G Jr, Lane HC, et al. Treatment of cytomegalovirus retinitis with dihydroxy propoxymethyl guanine . Am J Ophthalmol . 1986;101:95-101. 12. Collaborative DHPG Treatment Study Group. Treatment of serious cytomegalovirus infections with 9-(1,3-dihydroxy-2-propoxymethyl) guanine in patients with AIDS and other immunodeficiencies . N Engl J Med . 1986;314:801-805.Crossref 13. Rosecan LR, Stahl-Bayliss CM, Kalman CM, Laskin OL. Antiviral therapy for cytomegalovirus retinitis in AIDS with dihydroxy propoxymethyl guanine . Am J Ophthalmol . 1986;101:405-418. 14. Jabs DA, Wingard JR, de Bustros S, de Miranda P, Saval R, Santos GW. BW B759U for cytomegalovirus retinitis: intraocular drug penetration . Arch Ophthalmol . 1986;104:1436-1437.Crossref 15. D'Amico DJ, Talamo JH, Felsenstein D, Hirsch MS, Albert DM, Schooley RJ. Ophthalmoscopic and histologic findings in cytomegalovirus retinitis treated with BW-B759U . Arch Ophthalmol . 1986;104:1788-1793.Crossref 16. Henderly DR, Freeman WR, Causey DM, Rao NA. Cytomegalovirus retinitis with response to therapy with ganciclovir . Ophthalmology . 1987;94;425-434. 17. Holland GN, Sidikaru Y, Kreiger AE, et al. Treatment of cytomegalovirus retinopathy with ganciclovir . Ophthalmology . 1987;94:815-823.Crossref 18. Jabs DA, Newman C, de Bustros S, Polk BF. Treatment of cytomegalovirus retinitis with ganciclovir . Ophthalmology . 1987;94:824-830.Crossref 19. Orellana J, Teich SA, Friedman AH, Lerebours F, Winterkorn J, Mildram D. Combined short- and long-term therapy for the treatment of cytomegalovirus retinitis using ganciclovir (BW B759U) . Ophthalmology . 1987;94:831-838.Crossref 20. Henry K, Cantrill H, Fletcher C, Chinnock BJ, Balfour HH. Use of intravitreal ganciclovir (dihydroxy propoxymethyl guanine) for cytomegalovirus retinitis in a patient with AIDS . Am J Ophthalmol . 1987;103:17-23. 21. Fischl MA, Richman DD, Grieco MH, et al. The efficacy of 3′-azido-3′-deoxythymidine (azidothymidine) in the treatment of patients with AIDS and AIDS-related complex: a double-blind placebo-controlled trial . N Engl J Med . 1987;317:185-191.Crossref 22. Brigati DJ, Myerson D, Learry JJ, et al. Detection of viral genomes in cultured cells and paraffin-embedded tissue sections using biotinlabeled hybridization probes . Virology . 1983;126:32-50.Crossref 23. Unger ER, Budgeon LR, Myerson D, et al. Viral diagnosis by in situ hybridization: description of a rapid simplified colorimetric method . Am J Surg Pathol . 1986;10:1-8.Crossref 24. Hsu SM, Raine L, Fanger H. Use of avidinbiotin-peroxidase complex (ABC) in immunoperoxidase techniques: a comparison between ABC and unlabelled antibody (PAP) procedures . J Histochem Cytochem . 1981;29:577.Crossref 25. Richman DD, Fischl MA, Grieco MH, et al. The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: a double-blind, placebo-controlled trial . N Engl J Med . 1987;317:192-197.Crossref 26. Pomerantz RJ, Kuritzkes DR, De la Monte SM, et al. Infection of the retina by human immunodeficiency virus type I . N Engl J Med . 1987;317:1643-1647.Crossref 27. Skolnick PR, Kosloff BR, Hirsch MS. Bidirectional interactions between human immunodeficiency virus type 1 (HIV-1) and cytomegalovirus . J Infect Dis . 1988;157:508-514.Crossref 28. Fay MT, Freeman WR, Wiley CA, Hardy D, Bozzette S. Atypical retinitis in patients with the acquired immunodeficiency syndrome . Am J Ophthalmol . 1988;105:483-490. 29. D'Amico DJ, Skolnick PR, Kosloff BR, et al. Resolution of cytomegalovirus with zidovudine therapy . Arch Ophthalmol . 1988;106:1168-1169.Crossref 30. Jabs DA, Enger C, Bartlett JD. Cytomegalovirus retinitis and acquired immunodeficiency syndrome . Arch Ophthalmol . 1989;107:75-80.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Jun 1, 1989

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