CMV retinitis in China and SE Asia: the way forward

Cytomegalovirus (CMV), a member of the herpesvirus family, was a familiar, potentially blinding and lethal opportunistic infection in high income countries prior to the introduction of highly active anti-retroviral therapy (HAART). As the burden of the epidemic shifted to middle and low income countries, CMV retinitis, the most common AIDS-related clinical manifestation of CMV disease, became the "neglected disease of the AIDS pandemic" [1]. The current report by Shi, et al [2] brings important attention to this problem in China: CMV retinitis was found in 16.8% (19/113) of HIV-infected inpatients having CD4 counts < 50 cells/μL (the high-risk group). The data from Shanghai complement accounts of CMV retinitis from Beijing [3] and Guangzhou [4], and is consistent with our personal observation of a similar burden of CMV retinitis during training projects and clinical work in HIV clinics and infectious disease hospitals between 2006-2010, in Hubei province and the Autonomous Regions of Guangxi and Xinjiang. Although the authors appropriately suggest that we acquire better epidemiologic data, the key point is that there is adequate evidence that AIDS-related CMV retinitis is a common clinical problem in China, as in SE Asia [1].The visual consequences of CMV retinitis are disastrous. In the current report [2], 20.8% (5/24) of eyes with CMV retinitis were blind at diagnosis. In reports from Thailand [5,6], 31.2% (92/295) and 31.5% (165/523) of eyes were blind at diagnosis, and in a report from multiple sites [1], 35.9% (37/103) of eyes with CMV retinitis were blind.This staggering level of blindness is actually worse than the simple numbers suggest, for three reasons. First, the vision loss resulting from CMV retinitis is commonly severe, with one prior report showing only hand motion (HM) vision or worse in 33/37 (89.2%) of eyes blinded by CMV [1]. The World Health Organization (WHO) defines blindness as < 3/60 visual acuity, which at the bedside equates to an inabilit