What is the role of cytomegalovirus (CMV) in the ocular manifestations of HIV infection?

Updated: Jul 21, 2021
  • Author: Luca Rosignoli, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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CMV is the most common cause of intraocular infection in patients with AIDS. This disease, which may result in blindness or death, represents a reactivation of latent CMV infection.

Primary infection by CMV usually is asymptomatic and is predominantly transmitted perinatally. In childhood, the major mode of transmission is by close contact, while in adolescence and adulthood, it is mostly transmitted through sexual contact or blood transfusion. The seropositive prevalence of CMV is about 50% in adults and 95-100% in homosexual and AIDS patients.

Reactivation of latent CMV infection commonly is seen in the setting of immunocompromise, such as in patients on long-term immunosuppressive therapy. Before the advent of highly active antiretroviral therapy (HAART), CMV was the most common opportunistic infection in AIDS patients with a CD4+ cell count below 50/µL. In the HAART era, the incidence of CMV retinitis has declined, and the survival after diagnosis has increased to well over 1 year.

CMV retinitis starts as a single lesion in most cases. Infection spreads centrifugally from that focus; new lesions are relatively uncommon, even persistent viremia. The spread of infection has been shown to be relentless in the setting of continued immunodeficiency, with advancement of lesion borders toward the fovea at a median rate of 24 µm/day.

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