Retinitis, HIV CMV
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
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H30.9 + (B20.2)
DESCRIPTION
- Cytomegalovirus (CMV) retinitis is seen in advanced HIV infection, with CD4 count < 100 cells/mm3.
- The characteristic retinal appearance is that of necrosis, i.e. white exudates, and haemorrhages at the edges of the exudates.
- Visual loss is irreversible – the goal of therapy is to limit further loss.
MEDICINE TREATMENT
Limited CMV retinitis:
- Valganciclovir, oral, 900 mg 12 hourly for the first 3 weeks, then 900 mg daily until immune recovery (CD4 > 100) and a minimum of 3 months of therapy with valganciclovir (if available).
LoE:IIIbxvii
- Monitor FBC weekly during induction, then monthly as valganciclovir can cause bone marrow suppression. Avoid concomitant zidovudine use.
- Initiate ART 2 weeks after starting induction therapy.
If valganciclovir is not available:
- Ganciclovir, intravitreal, 2 mg twice a week for three weeks then once a week (specialist)
- Once immune function has been restored with antiretroviral therapy (CD4 >100) and the features of active retinitis has cleared, maintenance ganciclovir can be stopped but monitor for recurrence.
REFERRAL
- To ophthalmologist for confirmation of diagnosis.
- Patients with extensive or wide-spread CMV infection to be managed by an infectious disease specialist.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.0_30 September 2024
Chapter 18 Eye Disorders_18.6 Retinitis, HIV CMV