Management of cytomegalovirus retinitis in HIV/AIDS patients: a systematic review

Abstract

Objective: To perform a systematic review of the literature on cytomegalovirus (CMV) retinitis, to describe its most common clinical manifestations, its relationship with CD4+ lymphocyte count and its therapeutic options.
Material and methods: An electronic search of the literature was conducted according to the PRISMA guidelines using the following keywords: cytomegalovirus, retinitis, HIV, AIDS and opportunistic infection. Articles selected were those —both in English and in Spanish— describing the characteristics of CMV retinitis in patients over 18 years of age with HIV infection and/or in those having acquired immunodeficiency virus.
Results: A total of 14 articles were selected for a literature review that included retrospective studies, systematic reviews, a prospective study and a case presentation. Articles analyzed had been published from 2000 to 2019. The population included was 372 patients with HIV/AIDS and CMV retinitis with an age range of 21 to 73 years, 341 of which were males and 31, females. CD4+ lymphocyte count values were predominantly <100 cells/µl. The diagnostic method used was funduscopy under pupil dilation by indirect microscopy and retinal findings were described.
Conclusion: CMV retinitis is a disease that should be diagnosed clinically. Ophthalmic evaluation is vital in HIV+ patients with lymphocyte counts <50 cells/µl, in whom this disease is more likely to occur. Evidence has shown that early diagnosis is associated with a reduction of its multiple complications, particularly those involving the visual system.

Key words: cytomegalovirus, retinitis, HIV, AIDS, opportunistic infection.