Case 7: A 43-Year-Old with New Visual SymptomsOpportunistic Infections: Treatment

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Case 7: A 43-Year-Old with New Visual Symptoms

You answered:

	In this situation, initiating antiretroviral therapy would be sufficient for treatment of the CMV retinitis. Specific therapy for CMV with valganciclovir (Valcyte) or a ganciclovir intraocular implant (Vitrasert) would not be necessary.

This answer is incorrect. Antiretroviral therapy alone is not appropriate therapy for CMV retinitis, especially in a patient who has already experienced loss of visual acuity. Most experts would recommend treatment with oral valganciclovir (Valcyte) with or without a ganciclovir intraocular implant (Vitrasert). The optimal time to initiate antiretroviral therapy in patients with acute CMV retinitis has not been clearly established.

Choose another answer:

	Cytomegalovirus (CMV) retinitis in HIV-infected patients usually results from reactivation disease in persons previously infected with CMV.
	The patient in this case history had unusual presenting manifestations for CMV retinitis. Most patients present with eye pain, conjunctival erythema, and visual loss.
	The diagnosis of CMV retinitis should be confirmed in all patients with suspected CMV retinitis by detecting CMV (using PCR-based techniques) in vitreous fluid.

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