Suspension of anticytomegalovirus maintenance therapy following immune recovery due to highly active antiretroviral therapy

Abstract

Aim - To describe the authors' experience with discontinuation of anti-cytomegalovirus (CMV) maintenance therapy in patients showing immune recovery following highly active antiretroviral therapy (HAART). Methods - Retrospective analysis of the records of 41 patients who presented with CMV retinitis and whose maintenance therapy was discontinued from March 1997 to December 1999. Results - 41 patients had their anti-CMV therapy discontinued. The mean follow up after discontinuation of maintenance therapy in April 2000 was 20.4 months. At the time of discontinuation of maintenance therapy the lowest CD4+ count was 143 cells ×106/1 and only three patients had detectable HIV viral load. No reactivation or progression was seen in any of these patients after suspension of maintenance therapy. Conclusion - The anti-CMV maintenance therapy could be discontinued safely in patients with CD4+ above 150 cells ×106/1 although close follow up remains necessary especially in patients whose CD4+ count drops below this level.