I hope I find you in good health. One of the most distressing things I have experienced as a doctor has been to explain to my patient that they have lost their sight. Also explaining that there is nothing that can be done by anyone to reverse this situation. This is one the most agonizing illness to be experienced by anyone and yet this is exactly what happens with cytomegalovirus (CMV) infection.
The cytomegalovirus is related to the herpes virus and is present in almost everyone. It is one of the most common types of virus that infects those who are living positively. Normally, most people's immune systems are able to fight the virus, preventing it from causing problems in their bodies. However, when the immune system is suppressed because of AIDS, organ or bone marrow transplant, or chemotherapy, the CMV virus can cause damage and disease to the eye and the rest of the body.
CMV retinitis, is nowadays one of the most common severe infection affecting the eye in patients with late-stage AIDS. The disease typically occurs during the late stages of AIDS when individuals have a T cell , or CD4 count, of less than 100. Left untreated, CMV can take a person's sight within two to six months. In the past, about one-fourth of active AIDS patients developed CMV retinitis. However, this figure appears to be dropping thanks to a potent combination of antiretroviral, drugs which help restore the function of the immune system.
CMV retinitis is caused by the cytomegalovirus, a very common virus: about 80% of adults harbor antibodies to CMV, which indicates their bodies have successfully fought it off. The difference for people who have AIDS is that their weakened or non-functioning immune system cannot stave off this virus.

CMV retinitis may affect one eye at first, but usually progresses to both eyes and becomes worse as the patient's ability to fight infection decreases. Patients with CMV retinitis are at risk of retinal detachment, haemorrhages, and inflammation of the retina that can lead to permanent loss of vision and even blindness.
CMV retinitis usually causes symptoms, but not always. Patients with any condition that suppresses the immune system should watch for the following eye symptoms while under the care of a physician, seeing moving black spots known as "floaters," (spots, bugs, spider webs),light flashes, blind spots, blurred vision, obstructed areas of vision and sudden decrease or loss of vision. The eyes can also become painful or red or become sensitive to light (photophobia) These symptoms may not necessarily mean that you have CMV retinitis. However, if you experience one or more of these symptoms, contact your doctor for a complete exam.
CMV retinitis is diagnosed through a standard eye examination. Dilation of the pupils and indirect ophthalmoscopy will show signs of CMV retinitis.
The objective of treatment is to prevent progression of the disease, which can lead to blindness. Therapy must be continued indefinitely, or until blindness occurs. Intravenous ganciclovir, foscarnet, and cidofovir have all been shown to improve CMV retinitis.
Once the patient is improving, the drugs can sometimes be taken orally instead. Sometimes, however, CMV is resistant to these drugs. Also, ganciclovir can deplete white blood cells, and cidofovir and foscarnet can cause kidney damage.

The biggest treatment breakthrough is highly active antiretroviral therapy (HAART), a combination of drugs that suppress the human immunodeficiency virus (HIV), also known as the AIDS virus. HAART allows your immune system to recover and fight off infections like CMV retinitis.
Your doctor may suggest you continue taking anti-CMV drugs for the first three months or so of HAART, sometimes patients' immune response improves right away, but CMV retinitis takes a little longer.
Symptomatic CMV infection normally occurs only in immunocompromised individuals. Avoiding the primary cause of immune deficiency, AIDS, will therefore prevent symptomatic CMV infection.
Progression of the disease is common, even when therapy continues, because antiviral medications stop the replication of the virus but do not destroy it. CMV is itself immunosuppressive and may worsen the symptoms of other causes of immunosuppression. Routine eye check by the doctor is very important especially for those patients with a CD4 count below 50. If the disease is picked up early then intervention to delay progression to blindness will also be done early.
Till next week take care of yourself and each other. Remember, "…. in all your getting, get understanding."
Also, ganciclovir can deplete white blood cells, and cidofovir and foscarnet can cause kidney damage.
The biggest treatment breakthrough is highly active antiretroviral therapy (HAART), a combination of drugs that suppress the human immunodeficiency virus (HIV), also known as the AIDS virus. HAART allows your immune system to recover and fight off infections like CMV retinitis.
Your doctor may suggest you continue taking anti-CMV drugs for the first three months or so of HAART, sometimes patients' immune response improves right away, but CMV retinitis takes a little longer.
Symptomatic CMV infection normally occurs only in immunocompromised individuals. Avoiding the primary cause of immune deficiency, AIDS, will therefore prevent symptomatic CMV infection.
Progression of the disease is common, even when therapy continues, because antiviral medications stop the replication of the virus but do not destroy it. CMV is itself immunosuppressive and may worsen the symptoms of other causes of immunosuppression. Routine eye check by the doctor is very important especially for those patients with a CD4 count below 50. If the disease is picked up early then intervention to delay progression to blindness will also be done early.
Till next week take care of yourself and each other. Remember, "…. in all your getting, get understanding."