Discontinuation of maintenance CMV therapy in HAART responders.

The effectiveness of highly active antiretroviral therapy (HAART) in suppressing HIV and restoring some immune system function has enabled some patients to discontinue additional maintenance therapy for cytomegalovirus (CMV) retinitis. Research from the ICAAC conference in 1997 and the Ocular Immunology Service at the Johns Hopkins Hospital suggest that anti-CMV therapy can be successfully stopped in certain patients. There are no guidelines for discontinuing CMV therapy, and researchers have to rely on the results of clinical trials. ACTG 379 and ACTG 350 are studies attempting to measure time to reactivation after termination of CMV therapy, and CMV viral load after cessation of therapy, respectively. These studies will be useful in determining therapy option, and length of treatment. It is suggested that clinicians resume anti-CMV therapy in patients whose CD4 counts dip below 50 cells/mm3, and monitor all patients monthly for changes and for signs of immune recovery vitritis.