AIDS Combined With CMVR Systemic Antiviral Therapy Union Vitreous Injection Of Ganciclovir

Objective:The study and follow-up of ganciclovir by intravitreal injection of acquired immune deficiency syndrome(AIDS)with cytomegalovirus retinitis(CMVR)patients.To discuss the dosage,time and course of intraocular injection,and to further study the relationship between CMV-DNA viral load in intraocular fluid and CD4~+T cell counts in blood before and after injection.To supplement the clinical diagnosis and treatment of CMVR.Methods:In the First Affiliated Hospital of Guangxi Medical University,13eyes of 7 cases AIDS patients diagnosed with CMVR by FFA were collected from January 2016 to January 2018.Each patient was given an intraocular injection of 800μg/0.08ml,1 times a week,4 times,while systemic administration of ganciclovir and phosphonoformate intravenous injection.The results of the best corrected visual acuity(BCVA),intraocular pressure(IOP),fundus photography,fluorescence fundus angiography(FFA),visual evoked response(VEP),electro-oculogram(EOG),electroretinogram(ERG)and the CMV-DNA viral load in blood,vitreum and anterior chamber fluid and CD4~+T cell count in blood before and after multiple intraocular injection were collected and analyzed statistically.Results:(1)The BCVA after treatment is better than before treatment(z=-3.181 P=0.001).(2)No significant difference in IOP before and after treatment(t=1.677,P=0.119).(3)The lesions of the fundus of the patients were gradually reduced after intravitreal injection of ganciclovir(H=13.826,P=0.000).(4)A positive linear regression relationship between the CMV-DNA virus load of the vitreum and the load of CMV-DNA virus of the anterior chamber fluid after intravitreal injection of ganciclovir(t=3.217,P=0.008).(5)The CMV-DNA virus load of the vitreum is significantly lower after 4 intravitreal injection of ganciclovir(z=-2.353,P=0.019)and the load of CMV-DNA virus of the anterior chamber fluid is also significantly lower than that before(z=-2.31,P=0.021).(6)In 5 eyes of 3 cases,CMVR was diagnosed by FFA examination.A large number of CMV-DNA virus loads were detected in both anterior chamber fluid and vitreum,but the test of blood test for CMV-DNA virus was negative.(7)Before treatment,the CD4~+T cell count was negatively correlated with the CMV-DNA virus load in anterior chamber fluid(r=-0.806 P=0.001),the CMV-DNA virus load in vitreum(r=-0.769P=0.002),the CMV-DNA virus load in blood(r=-0.665 P=0.013).Conclusion:(1)Intravenous antiviral drugs combined with intravitreal injection of small dose of ganciclovir is a safe and effective treatment for AIDS combined with CMVR.(2)There is a positive linear regression relationship between the CMV-DNA viral load of the anterior chamber fluid and the CMV-DNA viral load of the vitreum before and during the treatment.We can predict the CMV-DNA viral load of the vitreum through the CMV-DNA viral load of the anterior chamber fluid which can assist in the diagnosis of CMVR and the monitoring of the curative effect.(3)CMV infection in the eye can be the first symptom of AIDS patients.Even for patients with negative serum CMV-DNA viral load,it is not possible to exclude the possibility of CMVR.(4)CD4~+T cell count is an important indicator of AIDS,which has a relationship with the CMV-DNA viral load in of the blood,the vitreum,the anterior chamber fluid.(5)CMVR is a terminal organ disease of AIDS patients.It needs early treatment.Early intravitreal injection of ganciclovir combined with systemic antiviral drugs can better preserve patient’s visual function.