Antiretroviral therapy in AIDS patients with CMV disease: Impact on the survival and long-term treatment outcome

Objectives: To determine the impact of antiretroviral therapy (ART) on the long-term survival of AIDS patients with CMV disease and evaluate long-term outcomes of ART. Methods: A retrospective cohort study was conducted among HIV-infected patients with CMV disease in a medical school hospital during 1996-2005 and followed-up until June 2007. Results: There were 154 patients, mean age 34.5 years and 57.8% were male. Organ involvement of CMV disease included retina (94.8%), central nervous system, lungs, and gastrointestinal tract. Median CD4 cell count was 20 cells/mm³ and 99 patients received ART. During median follow-up of 32 months (interquartile range 23-96), 29.2% of patients died. From Kaplan-Meier analysis, median survival is significantly longer in patients receiving ART (>116.2 vs. 21.6 months, log-rank test, p < 0.001). From Cox's proportional hazard model, ART (HR 0.6, p < 0.001) and previous opportunistic infections (HR 3.5, p = 0.025) were negatively and positively associated with death, respectively. At median time of 69 months (interquartile range 34-101) in patients who received ART, 80.8% had HIV-1 RNA <50 copies/mL and median CD4 was 421 cells/mm³. One patient had immune reconstitution syndrome at 3 months after initiation of ART and resulted in permanent vision loss. Conclusions: ART significantly improves long-term survival of AIDS patients with CMV disease. Long-term virological and immunological outcomes are durable.