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PubMed · 7667006

CMV retinitis.

Abstract

BACKGROUND: Cytomegalovirus (CMV) retinitis is the most common ocular opportunistic infection in patients with AIDS. CMV retinitis is often asymptomatic and usually appears when the patient's CD4 lymphocyte levels fall below 50/mm3. The infection may present a variety of clinical appearances and must be carefully differentiated from cotton-wool spots in early infection. PURPOSE: This paper reviews the natural history of CMV infection in both the normal population and in patients with AIDS. CMV retinitis presenting in AIDS patients is then described in detail with clinical presentations of fundus features. Finally, the management of patients who may be at risk or have developed CMV retinitis is reviewed. Recent data on suggested management protocols are also provided. CONCLUSIONS: Cases of CMV retinitis will continue to increase as the AIDS epidemic progresses. The primary care practitioner will play an increasingly important role in the diagnosis and management of patients with this infection.

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BibTeXRIS

R Ballinger. 1995. CMV retinitis.. https://doi.org/10.1097/00006324-199505000-00006

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Up-regulation of Fas ligand expression by human cytomegalovirus immediate-early gene product 2: a novel mechanism in cytomegalovirus-induced apoptosis in human retina.

Human CMV (HCMV) is an important pathogen that causes widespread diseases in immunocompromised individuals. Among the opportunistic HCMV infections, HCMV retinitis is most common in transplant recipients and AIDS patients. It often leads to blindness if left untreated. The question as to how HCMV infection causes retinal pathogenesis remains unresolved. Here, we report that viral immediate-early gene product 2 (IE2), but not IE1, up-regulates the Fas ligand (FasL) expression in HCMV-infected human retinal pigment epithelium cells. Increased secretion of FasL from virally infected cells into cultured medium was observed upon HCMV infection. The capability of such cell-free medium to induce apoptosis of Fas (CD95)-expressing Jurkat cells further implies that Fas-FasL interaction might mediate cell death in the lesion of HCMV retinitis. To support this idea, we observed augmented soluble FasL levels in vitreous from AIDS patients with HCMV retinitis as compared with that from AIDS patients without HCMV infection. In addition, by in situ hybridization and immunohistochemistry, we detected enhanced signals of FasL, the existence of viral IE Ags and apoptotic cells at the same sites in the lesion of HCMV-infected retina. These results strongly suggest that IE2 induction of FasL expression in human retina might be an important event that takes place in the early stage of infection and finally leads to visual loss in individuals affiliated with HCMV retinitis.

AIDS-Related Opportunistic Infections↗

Viral load as an independent risk factor for opportunistic infections in HIV-infected adults and adolescents.

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AIDS-Related Opportunistic Infections↗