Comparison of prognosis of cytomegalovirus retinitis induced by AIDS and HSCT postoperation

doi:10.3877/cma.j.issn.2095-2007.2020.01.003

Abstract

Abstract:

Objective

To explore the prognosis of cytomegalovirus retinitis (CMVR) induced by two different etiologies.

Methods

From May 2015 to October 2019, 32 CMVR patients (52 eyes) diagnosed in the department of Ophthalmology of Beijing You′an Hospital and Beijing Chaoyang Hospital affiliated to Capital Medical University. There were 27 males and 5 females, with an average age of (25.4±7.8) years. According to common causes, patients were divided into two groups; one group was acquired immune deficiency syndrome (AIDS) and the other group with the postoperative hematopoietic stem cell transplantation (HSCT) . 32 patients were treated with ganciclovir and (or) sodium phosphonate intravitreal injection combined with systemic therapy and followed up for 6 months. Analysis of the best corrected visual acuity (BCVA), intraocular pressure, fundus and cytomegalovirus virus (CMV)-DNA in anterior chamber, CD4⁺ T cells in blood was made before and after the treatment. Intraocular pressure was represented as expressed in mean ± SD and compared with t test. BCVA, the number of CD4⁺ T cells in blood and the content of CMV-DNA in aqueous humor were expressed in median (minimum, maximum) and compared with Wilcoxon rank sum test. Counting data was expressed by frequency or rate (%) and compared with Chi-square test.

Results

Before treatment, the BCVA of patients in the AIDS group and the HSCT postoperative group were 0.36 (0.02, 1.00) and 0.21 (0.01, 0.60). After treatment, the BCVA of patients in the AIDS group and the HSCT postoperative group were 0.53 (0.05, 1.00) and 0.36 (0.02, 0.80). With Wilcoxon rank sum test, there was no significant difference in BCVA between two groups of patients before treatment (Z=-0.23, P>0.05). The BCVA in the AIDS group was higher than that in the HSCT postoperative group after treatment (Z=-2.05, P<0.05). Before treatment, the intraocular pressure of patients in the AIDS group and in the HSCT postoperative group were (11.9±2.8)mmHg (1 mmHg=0.133 kPa) and (12.8±2.2)mmHg. After treatment, the intraocular pressure of patients in the AIDS group and HSCT postoperative group were (13.4±2.7) and (13.9±3.5)mmHg. With t test, there was no significant difference in intraocular pressure between two groups of patients before and after treatment (t=-0.94, -0.54; P>0.05). Before treatment, the peripheral blood CD4⁺ T cell counts of patients in the AIDS group and HSCT postoperative group were 54 (0, 213) cells/μl and 47 (2, 87) cells/μl. After treatment, the peripheral blood CD4⁺ T cell counts of patients in the AIDS group and HSCT postoperative group were 139 (32, 371) cells/μl and 76 (21, 212) cells /μl. With Wilcoxon rank sum test, there was no significant difference in the peripheral blood CD4⁺ T cell counts between two groups of patients before treatment (Z=-0.65, P>0.05). The peripheral blood CD4⁺ T cell counts in the AIDS group were higher than that in the HSCT postoperative group after treatment (Z=-2.45, P<0.05). Before treatment, the CMV-DNA in the aqueous humor of the AIDS group and the HSCT postoperative group were 2.74×10⁴ (1.59×10³, 5.14×10⁵) copies/ml and 7.18×10³ (3.17×10³, 5.89×10⁵) copies/ml. After treatment, the CMV-DNA in the aqueous humor of the AIDS group and the HSCT postoperative group was 1.24×10 (0, 2.23×10²) copies/ml and 2.01×10 (0, 3.45×10²) copies/ml. With Wilcoxon rank sum test, there was no significant difference in CMV-DNA in aqueous humor between two groups of patients before and after treatment (Z=-0.68, -0.27; P>0.05). Recurrence of CMVR occurred in 3 eyes within 6 months of antiviral treatment in the HSCT postoperative group, and recurrence of CMVR occurred in 1 eye within six months of antiviral treatment in the AIDS group. Additionally, 55% patients in the HSCT group and only 18.8% patients in the AIDS group underwent intravitreal injections for 4 times and more than 4 times. The analysis of Chi-square test showed that there was a significant difference in the number of intravitreal injections 4 times or more between HSCT and AIDS patients (χ²=6.23, P<0.05).

Conclusions

Compared with AIDS-induced CMVR, CMVR induced by HSCT has more severe visual impairment, slower recovery of immune function during treatment, which requires longer-term intraocular antiviral treatment.

Key words: Cytomegalovirus retinitis, Acquired immune deficiency syndrome, The postoperative hematopoietic stem cell transplantation

Wenjun Kong, Yong Tao, Chao Chen, Lianyong Xie, Kuifang Du. Comparison of prognosis of cytomegalovirus retinitis induced by AIDS and HSCT postoperation[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2020, 10(01): 13-19.

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组别	眼数	BCVA [M(Min，Max)]		CD4⁺T淋巴细胞计数[M(Min，Max)](个/μl)		房水CMV-DNA值[M(Min，Max)](拷贝/ml)
组别	眼数	治疗前	治疗6个月后	治疗前	治疗6个月后	治疗前	治疗6个月后
AIDS组	32	0.36(0.02，1.00)	0.53(0.05，1.00)	54(0，213)	139(32，371)	2.74×10⁴(1.59×10³，5.14×10⁵)	1.24×10(0，2.23×10²)
HSCT术后组	20	0.21(0.01，0.60)	0.36(0.02，0.80)	47(2，87)	76(21，212)	7.18×10³(3.17×10³，5.89×10⁵)	2.01×10(0，3.45×10²)
Z值		-0.23	-2.05	-0.65	-2.45	-0.68	-0.27
P值		>0.05	<0.05	>0.05	<0.05	>0.05	>0.05

组别	眼数	BCVA [M(Min，Max)]		CD4⁺T淋巴细胞计数[M(Min，Max)](个/μl)		房水CMV-DNA值[M(Min，Max)](拷贝/ml)
组别	眼数	治疗前	治疗6个月后	治疗前	治疗6个月后	治疗前	治疗6个月后
AIDS组	32	0.36(0.02，1.00)	0.53(0.05，1.00)	54(0，213)	139(32，371)	2.74×10⁴(1.59×10³，5.14×10⁵)	1.24×10(0，2.23×10²)
HSCT术后组	20	0.21(0.01，0.60)	0.36(0.02，0.80)	47(2，87)	76(21，212)	7.18×10³(3.17×10³，5.89×10⁵)	2.01×10(0，3.45×10²)
Z值		-0.23	-2.05	-0.65	-2.45	-0.68	-0.27
P值		>0.05	<0.05	>0.05	<0.05	>0.05	>0.05

组别	眼数	注药次数<4次	注药次数≥4次
AIDS组	32	81.3(26/32)	18.8(6/32)
HSCT术后组	20	45(9/20)	55(11/20)
χ²值		6.231
P值		<0.05

组别	眼数	注药次数<4次	注药次数≥4次
AIDS组	32	81.3(26/32)	18.8(6/32)
HSCT术后组	20	45(9/20)	55(11/20)
χ²值		6.231
P值		<0.05

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