The longest follow-up yet reported on individuals who have stopped CMV maintenance treatment suggests that it is safe to stop treatment if the CD4 count rises above 100-150 on HAART.
14 individuals with CD4 counts greater than 150 receiving maintenance treatment with either ganciclovir, foscarnet or cidofovir were followed for an average of 16 months after stopping CMV treatment. All were receiving HAART with at least three drugs. 12/14 had documented immune recovery uveitis at baseline; this condition worsened in three individuals during the study.
During the follow-up period, no progression of CMV disease was reported, and the median CD4 count of all participants rose above 300. Nine individuals were intermittently positive for CMV but experienced no flare-up of CMV disease.
The authors noted that no participants had immediately sight-threatening retinitis, and that individuals with more severe but currently stable retinitis should not stop maintenance treatment unless frequent opthalmic examinations are possible.
Reference
Whitcup SM et al. Discontinuation of anticytomegalovirus therapy in patients with HIV infection and cytomegalovirus retinitis. Journal of the American Medical Association 282: 17, 1633-1637, 1999. Click here to view the full text