Cytomegalovirus Retinitis Management
Discontinuation Criteria
- The CDC/NIH/IDSA guidelines recommend discontinuing secondary prophylaxis for patients with a sustained (3-6 months) increase in CD4+ counts >100 cells/µL in response to ART 1, 2, 3, 4, 5, 6, 7, 8
- A patient must have maintained a CD4 count >100 cells/µL for at least 3 months to be considered for discontinuation of valganciclovir maintenance therapy 1, 2, 3, 4, 5, 6, 7, 8
Monitoring and Maintenance
- The CDC recommends monthly CD4 count monitoring to document sustained elevation 1, 2, 3, 4, 5
- Continue valganciclovir maintenance at 900 mg once daily until the patient has maintained CD4 >100 cells/µL for at least 3 months (ideally 6 months) 1, 2, 3, 4, 5, 6, 7, 8
Risk of Relapse
- The relapse rate is 3% per year (0.03 per person-year) even with appropriate discontinuation criteria met 1, 3, 4, 6
- Relapses can occur even at high CD4 counts, such as 1,250 cells/µL 1, 3, 4, 6