Wednesday, November 14, 2012

What is CMV Retinitis?

We have been assisting patients in RITM-ARG for CMV Retinitis Treatment. PLHIV's usually come to us for medical assistance because the lab tests and treatment are quite expensive. The Love Fund can only assist PLHIV's initially, however because treatment is long, we always refer them to the Philippine Charity Sweepstakes Office (PCSO) for prolonged medical assistance.

What really is CMV Retinitis? Like what I always do, I made a research about it in the net.

Cytomegalovirus (CMV) Retinitis

Cytomegalovirus retinitis, also known as CMV retinitis, is an inflammation of the eye's retina that can lead to blindness. It is the most common HIV ocular complication. 

(CMV) is a ubiquitous DNA virus that infects the majority of the adult population. In the immunocompetent host, infection is generally asymptomatic or limited to a mononucleosis-like syndrome. Like many other herpes viruses, CMV remains latent in the host and may reactivate if host immunity is compromised.

In immunocompromised individuals, primary infection or reactivation of latent virus can lead to opportunistic infection of multiple organ systems. In the eye, CMV most commonly presents as a viral necrotizing retinitis with a characteristic ophthalmoscopic appearance Untreated CMV retinitis inexorably progresses to visual loss and blindness.

Transmission of CMV occurs through placental transfer, breast milk, saliva, sexually transmitted fluids, blood transfusions, and organ or bone marrow transplants. In the immunocompetent pediatric or adult host, infection is generally asymptomatic or limited to a mononucleosis-like syndrome with signs and symptoms including fever, myalgia, cervical lymphadenopathy, and mild hepatitis.

CMV generally dwells as a latent intracellular virus in immunocompetent children and adults. CMV may reactivate if host immunity is compromised. In immunocompromised individuals, primary infection or reactivation of latent virus can lead to opportunistic infection of multiple organ systems, including the skin (eg, rashes, ulcers, pustules), lungs (eg, interstitial pneumonitis), gastrointestinal tract (eg, colitis, esophagitis), peripheral nerves (eg, radiculopathy, myelopathy), brain (eg, meningoencephalitis), and eye (eg, retinitis, optic neuritis).

In the eye, CMV commonly presents as a viral necrotizing retinitis with vitreitis and may result in retinal detachment. Untreated CMV retinitis inexorably progresses to visual loss and blindness.

Symptoms

Some people with CMV retinitis have no symptoms.

Symptoms include:te if host immunity is compromised. In immunocompromised individuals, primary infection or reactivation of latent virus can lead to opportunistic infection of multiple organ systems, including the skin (eg, rashes, ulcers, pustules), lungs (eg, interstitial pneumonitis), gastrointestinal tract (eg, colitis, esophagitis), peripheral nerves (eg, radiculopathy, myelopathy), brain (eg, meningoencephalitis), and eye (eg, retinitis, optic neuritis).

In the eye, CMV commonly presents as a viral necrotizing retinitis with vitreitis and may result in retinal detachment. Untreated CMV retinitis inexorably progresses to visual loss and blindness.

Signs: Focal Necrotizing Retinitis
    • Retinal Hemorrhage, exudation, edema
    • Opaque lesions with patchy Hemorrhage and Vasculitis
    • Ischemic retinopathy
      1. Cotton wool spots (areas of ischemic infarction)
      2. Usually no Hemorrhage or edema
Tests

CMV retinitis is diagnosed through a standard ophthalmologic exam. Dilation of the pupils and opthalmoscopy will show signs of CMV retinitis.

CMV infection can be diagnosed with blood or urine tests that look for substances specific to the infection. A tissue biopsy can detect the viral infection and presence of CMV virus particles, but this is rarely done.
Risks
    • CD4 Count < 100
      1. Confers 20% CMV Retinitis risk in 2 years
      2. Usually occurs when CD4 Count < 50
    • Invasive Cytomegalovirus confers 90% retinitis risk
Course
    • Disease progresses rapidly
      1. Irreversible blindness in 2 weeks if not treated
    • Recurrence of CMV Retinitis
      1. Inevitable despite treatment (foscarnet, ganciclovir)
      2. Median 3-4 months (days-weeks without treatment)
      3. Ganciclovir implants may delay for 7 months
Complications
    1. Retinal Detachment with sudden loss of vision
Management

The goal of treatment is to stabilize or restore vision and prevent blindness. Long-term treatment is often needed. Medications may be given by mouth (orally), through a vein (intravenously), or injected directly into the eye (intraviteously).

Prevention
A CMV infection usually only causes symptoms in people with a weakened immune system. Certain medicines (like cancer therapy) and diseases (such as AIDS) can cause a weakened immune system.

People with AIDS who have a CD4 count of less than 100 should be examined regularly for this condition, even if they do not have symptoms. If you had CMV retinitis in the past, you should take preventative treatment for this condition even if your CD4 count stays below 100. If your count has been about 100 for 3-6 months, your doctor  may say you can safely stop the preventative treatment.

Monitoring
    1. Ophthalmology exam every 6 months (CD4 Count <100/mm3)
    2. Ophthalmology exam every 3 months (CD4 Count <50/mm3)
So if you have a low CD4, please talk to your doctor about CMV Retinitis. Empower ourselves with all the knowledge about the different OI's so we can easily prevent them and can get treatment if we have them.


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