David Heiden^*, Nathan Ford, David Wilson, William R. Rodriguez, Todd Margolis, Bart Janssens, Martha Bedelu, Nini Tun, Eric Goemaere, Peter Saranchuk, Kalpana Sabapathy, Frank Smithuis, Emmanuel Luyirika, W. Lawrence Drew

Funding: The authors received no specific funding for this article.

Competing Interests: The authors have declared that no competing interests exist.

Citation: Heiden D, Ford N, Wilson D, Rodriguez WR, Margolis T, et al. (2007) Cytomegalovirus Retinitis: The Neglected Disease of the AIDS Pandemic. PLoS Med 4(12): e334 doi:10.1371/journal.pmed.0040334

Published: December 1, 2007

Copyright: © 2007 Heiden et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abbreviations: CMV, cytomegalovirus; CNS, central nervous system; HAART, highly active antiretroviral therapy; IRU, immune recovery uveitis; MSF, Médecins Sans Frontières; WHO, World Health Organization

David Heiden is a consultant in uveitis, Department of Ophthalmology and Pacific Vision Foundation, California Pacific Medical Center, San Francisco, California, United States of America, and a consultant with the Seva Foundation, Berkeley, California, United States of America. Nathan Ford is with Médecins Sans Frontières, Bangkapi, Bangkok, Thailand. David Wilson is the Thailand Medical Coordinator with Médecins Sans Frontières, Bangkapi, Bangkok, Thailand. William R. Rodriguez is an Assistant Professor of Medicine at Harvard Medical School, Brigham and Women's Hospital, Clinton Foundation HIV/AIDS Initiative, Boston, Massachusetts, United States of America. Todd P. Margolis is Professor of Ophthalmology and Director, Francis I. Proctor Foundation for Research in Ophthalmology, University of California San Francisco, San Francisco, California, United States of America. Bart Janssens is with the International Committee of the Red Cross Burundi, Geneva, Switzerland, and was formerly a Medical Coordinator with Médecins Sans Frontières, Phnom Penh, Cambodia. Martha Bedelu is with Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa. Nini Tun is with the National Medical Coordination Team, Médecins Sans Frontières, Yangon, Myanmar. Eric Goemaere is Head of Mission, Médecins Sans Frontière, Khayelitsha, Cape Town, South Africa. Peter Saranchuk is a Medical Coordinator, Médecins Sans Frontières, Morija, Lesotho, formerly Beijing, China. Kalpana Sabapathy is HIV/AIDS Advisor, Médecins Sans Frontières, Amsterdam, Holland. Frank Smithuis is Head of Mission, Médecins Sans Frontières, Yangon, Myanmar. Emmanuel Luyirika is with the Mildmay Centre, Kampala, Uganda. W. Lawrence Drew is Professor of Laboratory Medicine and Medicine and Director of the Clinical Virology Laboratory at the University of California San Francisco, San Francisco, California, United States of America, and Director, Infectious Diseases Service, University of California Mount Zion Medical Center, San Francisco, California, United States of America.

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Cytomegalovirus (CMV), a member of the herpesvirus family, was a familiar cause of blindness and death in patients with advanced AIDS in Western countries prior to the introduction of highly active antiretroviral therapy (HAART). CMV retinitis then occurred in roughly one-third of patients with AIDS, and accounted for over 90% of cases of HIV-related blindness [1]. Extraocular CMV disease was a major cause of AIDS-related morbidity and mortality [2]. CMV retinitis is now clinically infrequent in patients with AIDS in developed countries, thanks to the widespread availability of HAART, although the problem has not disappeared [3,4]. Successful fundamentals of management are screening eye examinations in patients with low CD4 counts, and effective anti-CMV treatment with ganciclovir and related compounds, combined with HAART.

In developing regions of the world where the HIV/AIDS pandemic is rapidly unfolding, CMV retinitis is a neglected disease, largely undiagnosed and untreated...

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