CD4+ and CD8+ T lymphocyte levels prior to the diagnosis of CMV retinitis

Purpose: This study examined the decline in CD4 and CD8 levels in HIV seropositive patients who developed CMV retinitis. Methods: The records of HIV seropositive patients seen at the University of Texas Medical Branch in 1982-1995 were reviewed for T lymphocyte subsets prior to the onset of CMV retinitis. The ACCRP provides longitudinal, primary care for HIV-infected adults from a multi-county region of southeast Texas and for HIV-infected inmates of the Texas Department of Corrections. Results: Of 5,449 cases of HIV seropositive patients seen by the ACCRP, 1,551 patients had at least one CD4+ determination ≤ 50 CD4+/mm³ and 182 patients were diagnosed with CMV retinitis. The mean CD4+ was 32.54 ± 38/mm³ within ± 3 months of diagnosis of CMV retinitis, compared to 64.16 ± 75/mm³ within 6 to 12 months prior to the diagnosis of CMV retinitis (p<0.0005, unpaired student's t test). The mean CD8+ was 287± 217/mm³ within ± 3 months of diagnosis of CMV retinitis. The mean CD8+ was 479.97± 297/mm³ at 6 to 12 months prior to the diagnosis of CMV retinitis (p<0.0005). Conclusions: HIV seropositive patients who developed CMV retinitis had significantly lower mean CD4+ and CD8+ within ± 3 months of diagnosis of CMV retinitis compared to 6 to 12 months prior to the diagnosis. This data may have a predictive value for determining the optimal time to institute prophylactic treatment for CMV retinitis in HIV seropositive patients.