Foscarnet-ganciclovir cytomegalovirus retinitis trial: 5. Clinical features of cytomegalovirus retinitis at diagnosis

A. M K Gilpin, R. A. Lewis, P. Clogston, V. Fainstein, R. Gross, T. Samo, C. Tuttle, D. A. Jabs, L. Apuzzo, J. Bartlett, L. Coleson, J. P. Dunn, L. Eldred, J. Feinberg, T. Flynn, R. King, J. Leslie, B. Barron, D. Greenspan, C. LeCountG. Peyman, R. Franklin, B. Polsky, K. Squires, S. Wise-Campbell, A. H. Friedman, T. W. Cheung, N. Justin, S. Teich, H. Sacks, C. Severin, D. N. Friedberg, D. Dietrich, A. Addessi, K. Frost, D. Weinberg, L. Jampol, R. Murphy, K. Naughton, D. Henderly, G. N. Holland, S. Chafey, D. Hardy, H. Fall, L. MacArthur-Chang, W. R. Freeman, L. Meixnert, T. J. Peterson, J. I. Quiceno, L. Rickman, M. A. Simanello, S. Spector, J. O'Donell, J. Hoffman, A. Irvine, M. Jacobson, J. Larson, S. Seiff, Janet L Davis, E. Chuang, M. Espinal, Paul E. Mendez, R. Vandenbroucke, R. Cheeseman, J. Gittinger, R. Haubrich, H. Kachadoorian, K. Tolson, J. M. Kline, A. C. Klemm, M. Stecens, R. Webb, J. Brown-Bellamy, J. A. Markowitz, C. L. Meinert, R. Brookmeyer, L. Coleson, K. B. Collins, B. J. Collison, J. Dodge, M. Donithan, N. Fink, C. Gerzack, M. R. Isaacson, C. R. Levine, B. Martin, Y. I. Min, R. M. Owens, D. J. Nowakowski, A. Saah, S. Singer, M. Smith, A. L. Sternberg, J. Tonascia, M. L. Van Natta, M. D. Davis, M. Agres-Segal, J. Armstrong, J. Brickbauer

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

PURPOSE: To examine associations of systemic and ocular characteristics with severity of cytomegalovirus (CMV) retinitis at time of diagnosis and to compare ocular characteristics of eyes with and without CMV retinitis. METHODS: Eleven clinical centers, a data coordinating center, and a fundus photograph reading center participated in a randomized, controlled, multicenter clinical trial comparing foscarnet and ganciclovir as primary therapy for previously untreated CMV retinitis in 240 patients with AIDS. RESULTS: The systemic characteristics marginally associated with the percentage of retina affected by CMV in a patient's worse eye at diagnosis were chronic fever, weight loss, and number of HIV-related illnesses. A positive CMV blood culture at diagnosis was similarly associated with bilateral disease. Laboratory measures of disease did not correlate well with measures of CMV retinitis severity. Many eyes with CMV retinitis had no or minimal lesion hemorrhage, but most had signs of inflammation. Patients often repor-ted visual symptoms for involved eyes. The worse eyes (the eye with lesions covering the most retinal area) of patients with bilateral disease had greater retinal involvement, more lesions, and fewer degrees of visual field than did involved eves of patients with unilateral disease. Visual symptoms, inflammation, indolent retinitis, and hemorrhagic lesions were associated with a greater percentage of retina affected by CMV. CONCLUSIONS: The findings support viremia as a mechanism of spread for untreated disease. Visual symptoms and signs of ocular inflammation were indicators both of the presence of CMV retinitis and of greater extent of retinal area covered by CMV retinitis lesions.

Original languageEnglish
Pages (from-to)141-157
Number of pages17
JournalAmerican Journal of Ophthalmology
Volume124
Issue number2
StatePublished - Aug 21 1997
Externally publishedYes

Fingerprint

Cytomegalovirus Retinitis
Foscarnet
Ganciclovir
Cytomegalovirus
Inflammation
Retina
Retinitis
Viremia
Visual Fields
Multicenter Studies
Signs and Symptoms
Weight Loss
Reading
Acquired Immunodeficiency Syndrome
Fever
Randomized Controlled Trials
HIV
Hemorrhage

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Gilpin, A. M. K., Lewis, R. A., Clogston, P., Fainstein, V., Gross, R., Samo, T., ... Brickbauer, J. (1997). Foscarnet-ganciclovir cytomegalovirus retinitis trial: 5. Clinical features of cytomegalovirus retinitis at diagnosis. American Journal of Ophthalmology, 124(2), 141-157.

Foscarnet-ganciclovir cytomegalovirus retinitis trial : 5. Clinical features of cytomegalovirus retinitis at diagnosis. / Gilpin, A. M K; Lewis, R. A.; Clogston, P.; Fainstein, V.; Gross, R.; Samo, T.; Tuttle, C.; Jabs, D. A.; Apuzzo, L.; Bartlett, J.; Coleson, L.; Dunn, J. P.; Eldred, L.; Feinberg, J.; Flynn, T.; King, R.; Leslie, J.; Barron, B.; Greenspan, D.; LeCount, C.; Peyman, G.; Franklin, R.; Polsky, B.; Squires, K.; Wise-Campbell, S.; Friedman, A. H.; Cheung, T. W.; Justin, N.; Teich, S.; Sacks, H.; Severin, C.; Friedberg, D. N.; Dietrich, D.; Addessi, A.; Frost, K.; Weinberg, D.; Jampol, L.; Murphy, R.; Naughton, K.; Henderly, D.; Holland, G. N.; Chafey, S.; Hardy, D.; Fall, H.; MacArthur-Chang, L.; Freeman, W. R.; Meixnert, L.; Peterson, T. J.; Quiceno, J. I.; Rickman, L.; Simanello, M. A.; Spector, S.; O'Donell, J.; Hoffman, J.; Irvine, A.; Jacobson, M.; Larson, J.; Seiff, S.; Davis, Janet L; Chuang, E.; Espinal, M.; Mendez, Paul E.; Vandenbroucke, R.; Cheeseman, R.; Gittinger, J.; Haubrich, R.; Kachadoorian, H.; Tolson, K.; Kline, J. M.; Klemm, A. C.; Stecens, M.; Webb, R.; Brown-Bellamy, J.; Markowitz, J. A.; Meinert, C. L.; Brookmeyer, R.; Coleson, L.; Collins, K. B.; Collison, B. J.; Dodge, J.; Donithan, M.; Fink, N.; Gerzack, C.; Isaacson, M. R.; Levine, C. R.; Martin, B.; Min, Y. I.; Owens, R. M.; Nowakowski, D. J.; Saah, A.; Singer, S.; Smith, M.; Sternberg, A. L.; Tonascia, J.; Van Natta, M. L.; Davis, M. D.; Agres-Segal, M.; Armstrong, J.; Brickbauer, J.

In: American Journal of Ophthalmology, Vol. 124, No. 2, 21.08.1997, p. 141-157.

Research output: Contribution to journalArticle

Gilpin, AMK, Lewis, RA, Clogston, P, Fainstein, V, Gross, R, Samo, T, Tuttle, C, Jabs, DA, Apuzzo, L, Bartlett, J, Coleson, L, Dunn, JP, Eldred, L, Feinberg, J, Flynn, T, King, R, Leslie, J, Barron, B, Greenspan, D, LeCount, C, Peyman, G, Franklin, R, Polsky, B, Squires, K, Wise-Campbell, S, Friedman, AH, Cheung, TW, Justin, N, Teich, S, Sacks, H, Severin, C, Friedberg, DN, Dietrich, D, Addessi, A, Frost, K, Weinberg, D, Jampol, L, Murphy, R, Naughton, K, Henderly, D, Holland, GN, Chafey, S, Hardy, D, Fall, H, MacArthur-Chang, L, Freeman, WR, Meixnert, L, Peterson, TJ, Quiceno, JI, Rickman, L, Simanello, MA, Spector, S, O'Donell, J, Hoffman, J, Irvine, A, Jacobson, M, Larson, J, Seiff, S, Davis, JL, Chuang, E, Espinal, M, Mendez, PE, Vandenbroucke, R, Cheeseman, R, Gittinger, J, Haubrich, R, Kachadoorian, H, Tolson, K, Kline, JM, Klemm, AC, Stecens, M, Webb, R, Brown-Bellamy, J, Markowitz, JA, Meinert, CL, Brookmeyer, R, Coleson, L, Collins, KB, Collison, BJ, Dodge, J, Donithan, M, Fink, N, Gerzack, C, Isaacson, MR, Levine, CR, Martin, B, Min, YI, Owens, RM, Nowakowski, DJ, Saah, A, Singer, S, Smith, M, Sternberg, AL, Tonascia, J, Van Natta, ML, Davis, MD, Agres-Segal, M, Armstrong, J & Brickbauer, J 1997, 'Foscarnet-ganciclovir cytomegalovirus retinitis trial: 5. Clinical features of cytomegalovirus retinitis at diagnosis', American Journal of Ophthalmology, vol. 124, no. 2, pp. 141-157.
Gilpin AMK, Lewis RA, Clogston P, Fainstein V, Gross R, Samo T et al. Foscarnet-ganciclovir cytomegalovirus retinitis trial: 5. Clinical features of cytomegalovirus retinitis at diagnosis. American Journal of Ophthalmology. 1997 Aug 21;124(2):141-157.
Gilpin, A. M K ; Lewis, R. A. ; Clogston, P. ; Fainstein, V. ; Gross, R. ; Samo, T. ; Tuttle, C. ; Jabs, D. A. ; Apuzzo, L. ; Bartlett, J. ; Coleson, L. ; Dunn, J. P. ; Eldred, L. ; Feinberg, J. ; Flynn, T. ; King, R. ; Leslie, J. ; Barron, B. ; Greenspan, D. ; LeCount, C. ; Peyman, G. ; Franklin, R. ; Polsky, B. ; Squires, K. ; Wise-Campbell, S. ; Friedman, A. H. ; Cheung, T. W. ; Justin, N. ; Teich, S. ; Sacks, H. ; Severin, C. ; Friedberg, D. N. ; Dietrich, D. ; Addessi, A. ; Frost, K. ; Weinberg, D. ; Jampol, L. ; Murphy, R. ; Naughton, K. ; Henderly, D. ; Holland, G. N. ; Chafey, S. ; Hardy, D. ; Fall, H. ; MacArthur-Chang, L. ; Freeman, W. R. ; Meixnert, L. ; Peterson, T. J. ; Quiceno, J. I. ; Rickman, L. ; Simanello, M. A. ; Spector, S. ; O'Donell, J. ; Hoffman, J. ; Irvine, A. ; Jacobson, M. ; Larson, J. ; Seiff, S. ; Davis, Janet L ; Chuang, E. ; Espinal, M. ; Mendez, Paul E. ; Vandenbroucke, R. ; Cheeseman, R. ; Gittinger, J. ; Haubrich, R. ; Kachadoorian, H. ; Tolson, K. ; Kline, J. M. ; Klemm, A. C. ; Stecens, M. ; Webb, R. ; Brown-Bellamy, J. ; Markowitz, J. A. ; Meinert, C. L. ; Brookmeyer, R. ; Coleson, L. ; Collins, K. B. ; Collison, B. J. ; Dodge, J. ; Donithan, M. ; Fink, N. ; Gerzack, C. ; Isaacson, M. R. ; Levine, C. R. ; Martin, B. ; Min, Y. I. ; Owens, R. M. ; Nowakowski, D. J. ; Saah, A. ; Singer, S. ; Smith, M. ; Sternberg, A. L. ; Tonascia, J. ; Van Natta, M. L. ; Davis, M. D. ; Agres-Segal, M. ; Armstrong, J. ; Brickbauer, J. / Foscarnet-ganciclovir cytomegalovirus retinitis trial : 5. Clinical features of cytomegalovirus retinitis at diagnosis. In: American Journal of Ophthalmology. 1997 ; Vol. 124, No. 2. pp. 141-157.
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abstract = "PURPOSE: To examine associations of systemic and ocular characteristics with severity of cytomegalovirus (CMV) retinitis at time of diagnosis and to compare ocular characteristics of eyes with and without CMV retinitis. METHODS: Eleven clinical centers, a data coordinating center, and a fundus photograph reading center participated in a randomized, controlled, multicenter clinical trial comparing foscarnet and ganciclovir as primary therapy for previously untreated CMV retinitis in 240 patients with AIDS. RESULTS: The systemic characteristics marginally associated with the percentage of retina affected by CMV in a patient's worse eye at diagnosis were chronic fever, weight loss, and number of HIV-related illnesses. A positive CMV blood culture at diagnosis was similarly associated with bilateral disease. Laboratory measures of disease did not correlate well with measures of CMV retinitis severity. Many eyes with CMV retinitis had no or minimal lesion hemorrhage, but most had signs of inflammation. Patients often repor-ted visual symptoms for involved eyes. The worse eyes (the eye with lesions covering the most retinal area) of patients with bilateral disease had greater retinal involvement, more lesions, and fewer degrees of visual field than did involved eves of patients with unilateral disease. Visual symptoms, inflammation, indolent retinitis, and hemorrhagic lesions were associated with a greater percentage of retina affected by CMV. CONCLUSIONS: The findings support viremia as a mechanism of spread for untreated disease. Visual symptoms and signs of ocular inflammation were indicators both of the presence of CMV retinitis and of greater extent of retinal area covered by CMV retinitis lesions.",
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TY - JOUR

T1 - Foscarnet-ganciclovir cytomegalovirus retinitis trial

T2 - 5. Clinical features of cytomegalovirus retinitis at diagnosis

AU - Gilpin, A. M K

AU - Lewis, R. A.

AU - Clogston, P.

AU - Fainstein, V.

AU - Gross, R.

AU - Samo, T.

AU - Tuttle, C.

AU - Jabs, D. A.

AU - Apuzzo, L.

AU - Bartlett, J.

AU - Coleson, L.

AU - Dunn, J. P.

AU - Eldred, L.

AU - Feinberg, J.

AU - Flynn, T.

AU - King, R.

AU - Leslie, J.

AU - Barron, B.

AU - Greenspan, D.

AU - LeCount, C.

AU - Peyman, G.

AU - Franklin, R.

AU - Polsky, B.

AU - Squires, K.

AU - Wise-Campbell, S.

AU - Friedman, A. H.

AU - Cheung, T. W.

AU - Justin, N.

AU - Teich, S.

AU - Sacks, H.

AU - Severin, C.

AU - Friedberg, D. N.

AU - Dietrich, D.

AU - Addessi, A.

AU - Frost, K.

AU - Weinberg, D.

AU - Jampol, L.

AU - Murphy, R.

AU - Naughton, K.

AU - Henderly, D.

AU - Holland, G. N.

AU - Chafey, S.

AU - Hardy, D.

AU - Fall, H.

AU - MacArthur-Chang, L.

AU - Freeman, W. R.

AU - Meixnert, L.

AU - Peterson, T. J.

AU - Quiceno, J. I.

AU - Rickman, L.

AU - Simanello, M. A.

AU - Spector, S.

AU - O'Donell, J.

AU - Hoffman, J.

AU - Irvine, A.

AU - Jacobson, M.

AU - Larson, J.

AU - Seiff, S.

AU - Davis, Janet L

AU - Chuang, E.

AU - Espinal, M.

AU - Mendez, Paul E.

AU - Vandenbroucke, R.

AU - Cheeseman, R.

AU - Gittinger, J.

AU - Haubrich, R.

AU - Kachadoorian, H.

AU - Tolson, K.

AU - Kline, J. M.

AU - Klemm, A. C.

AU - Stecens, M.

AU - Webb, R.

AU - Brown-Bellamy, J.

AU - Markowitz, J. A.

AU - Meinert, C. L.

AU - Brookmeyer, R.

AU - Coleson, L.

AU - Collins, K. B.

AU - Collison, B. J.

AU - Dodge, J.

AU - Donithan, M.

AU - Fink, N.

AU - Gerzack, C.

AU - Isaacson, M. R.

AU - Levine, C. R.

AU - Martin, B.

AU - Min, Y. I.

AU - Owens, R. M.

AU - Nowakowski, D. J.

AU - Saah, A.

AU - Singer, S.

AU - Smith, M.

AU - Sternberg, A. L.

AU - Tonascia, J.

AU - Van Natta, M. L.

AU - Davis, M. D.

AU - Agres-Segal, M.

AU - Armstrong, J.

AU - Brickbauer, J.

PY - 1997/8/21

Y1 - 1997/8/21

N2 - PURPOSE: To examine associations of systemic and ocular characteristics with severity of cytomegalovirus (CMV) retinitis at time of diagnosis and to compare ocular characteristics of eyes with and without CMV retinitis. METHODS: Eleven clinical centers, a data coordinating center, and a fundus photograph reading center participated in a randomized, controlled, multicenter clinical trial comparing foscarnet and ganciclovir as primary therapy for previously untreated CMV retinitis in 240 patients with AIDS. RESULTS: The systemic characteristics marginally associated with the percentage of retina affected by CMV in a patient's worse eye at diagnosis were chronic fever, weight loss, and number of HIV-related illnesses. A positive CMV blood culture at diagnosis was similarly associated with bilateral disease. Laboratory measures of disease did not correlate well with measures of CMV retinitis severity. Many eyes with CMV retinitis had no or minimal lesion hemorrhage, but most had signs of inflammation. Patients often repor-ted visual symptoms for involved eyes. The worse eyes (the eye with lesions covering the most retinal area) of patients with bilateral disease had greater retinal involvement, more lesions, and fewer degrees of visual field than did involved eves of patients with unilateral disease. Visual symptoms, inflammation, indolent retinitis, and hemorrhagic lesions were associated with a greater percentage of retina affected by CMV. CONCLUSIONS: The findings support viremia as a mechanism of spread for untreated disease. Visual symptoms and signs of ocular inflammation were indicators both of the presence of CMV retinitis and of greater extent of retinal area covered by CMV retinitis lesions.

AB - PURPOSE: To examine associations of systemic and ocular characteristics with severity of cytomegalovirus (CMV) retinitis at time of diagnosis and to compare ocular characteristics of eyes with and without CMV retinitis. METHODS: Eleven clinical centers, a data coordinating center, and a fundus photograph reading center participated in a randomized, controlled, multicenter clinical trial comparing foscarnet and ganciclovir as primary therapy for previously untreated CMV retinitis in 240 patients with AIDS. RESULTS: The systemic characteristics marginally associated with the percentage of retina affected by CMV in a patient's worse eye at diagnosis were chronic fever, weight loss, and number of HIV-related illnesses. A positive CMV blood culture at diagnosis was similarly associated with bilateral disease. Laboratory measures of disease did not correlate well with measures of CMV retinitis severity. Many eyes with CMV retinitis had no or minimal lesion hemorrhage, but most had signs of inflammation. Patients often repor-ted visual symptoms for involved eyes. The worse eyes (the eye with lesions covering the most retinal area) of patients with bilateral disease had greater retinal involvement, more lesions, and fewer degrees of visual field than did involved eves of patients with unilateral disease. Visual symptoms, inflammation, indolent retinitis, and hemorrhagic lesions were associated with a greater percentage of retina affected by CMV. CONCLUSIONS: The findings support viremia as a mechanism of spread for untreated disease. Visual symptoms and signs of ocular inflammation were indicators both of the presence of CMV retinitis and of greater extent of retinal area covered by CMV retinitis lesions.

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