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Protease
Inhibitors May Cause Serious Eye Disease in Some AIDS
Patients, Study Finds AIDS patients who are given protease inhibitors to treat their HIV infection may develop cytomegalovirus (CMV) retinitis following the treatment, a University of California San Francisco study has found. CMV retinitis is a serious eye disease that affects 40 percent of patients with advanced AIDS and can lead to blindness. The study of five patients found that although protease inhibitor treatment was successful in fighting HIV infection as evidenced by a rise in patient CD4+ cells, the increase to approximately 200 cells per cubic millimeter from fewer than 100 did not protect them from developing CMV retinitis. "Previously we believed that patients who had CD4+ cell counts below 50 were susceptible to CMV retinitis," said Mark Jacobson, MD, associate professor of medicine at the UCSF AIDS Program at San Francisco General Hospital and the first author of the study published in the May 17 issue of Lancet. "Now we have found that patients can have counts well over 100 and still develop CMV retinitis and that it might be triggered by taking protease inhibitors." In the cases reported by the SFGH group, patients developed CMV retinitis within a few weeks. “Clinicians should be aware that patients with CD4+ cell counts well over 100 can be affected and that an increase in CD4+ cells following protease inhibitor treatment is not necessarily protective," Jacobson said. The cause of the phenomenon is not yet understood, he said. However, it is possible that as the patients responded well to the protease inhibitor therapy, the effect of their strengthened immune systems was to trigger the onset of CMV retinitis. This could happen, Jacobson said, as the protease inhibitors subdued the HIV infection sufficiently for the body to increase its infection-fighting CD4+ cells that are destroyed by HIV. Those new and increased numbers of infection-fighting cells would then seek out and "attack" CMV infection in the retina of the eye creating an inflammatory response in the process thus leading to CMV retinitis. By Alice Trinkl 1st appeared 6/06/97 |
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