CMV: The Neglected Disease of the AIDS Pandemic

Authors: David Heiden, Nathan Ford, David Wilson, William R. Rodriguez, Todd Margolis, Bart Janssens, Martha Bedelu, Nini Tun, Eric Goemaere, Peter Saranchuk, Kalpana Sabapathy, Frank Smithuis, Emmanuel Luyirika and W. Lawrence Drew

Cytomegalovirus (CMV), a member of the herpesvirus family, was a familiar cause of blindness and death in patients with advanced AIDS in Western countries prior to the introduction of highly active antiretroviral therapy (HAART). CMV retinitis then occurred in roughly one-third of patients with AIDS, and accounted for over 90% of cases of HIV-related blindness.

Extraocular CMV disease was a major cause of AIDS-related morbidity and mortality. CMV retinitis is now clinically infrequent in patients with AIDS in developed countries, thanks to the widespread availability of HAART, although the problem has not disappeared. Successful fundamentals of management are screening eye examinations in patients with low CD4 counts, and effective anti-CMV treatment with ganciclovir and related compounds, combined with HAART. In developing regions of the world where the HIV/AIDS pandemic is rapidly unfolding, CMV retinitis is a neglected disease, largely undiagnosed and untreated.

Workable diagnostic and therapeutic strategies have not yet been defined, and CMV is absent from current and pending World Health Organization (WHO) guidelines for the management of HIV in resource-limited settings. Similarly, the WHO’s ambitious “Vision 2020” program, which seeks to provide guidance on the use of ophthalmologic resources until the year 2020, fails to mention CMV retinitis.