Effect of anti-cytomegalovirus therapy on the incidence of immune recovery uveitis in AIDS patients with healed cytomegalovirus retinitis
To determine the association between anticytomegalovirus (CMV) maintenance therapy after immune recovery and immune recovery uveitis in acquired immunodeficiency syndrome (AIDS) patients on highly active antiretroviral therapy (HAART). Observational cohort study. Data were obtained on AIDS patients...
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| Veröffentlicht in: | American journal of ophthalmology 2003-10, Vol.136 (4), p.696-702 |
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| creator | Song, Mi-Kyoung Azen, Stanley P Buley, Ann Torriani, Francesca Cheng, Lingyun Chaidhawangul, Sunan Ozerdem, Ugur Scholz, Barbara Freeman, William R |
| description | To determine the association between anticytomegalovirus (CMV) maintenance therapy after immune recovery and immune recovery uveitis in acquired immunodeficiency syndrome (AIDS) patients on highly active antiretroviral therapy (HAART).
Observational cohort study.
Data were obtained on AIDS patients with CMV retinitis followed up at the AIDS Ocular Research Unit of University of California San Diego from November 1995 to October 1999. Immune recovery was defined as CD4 count greater than 50 cells/μl for more than 3 months. Patients with immune recovery uveitis presented with vitritis, cystoid macular edema, or epiretinal membrane. Statistical analyses were conducted to determine the risk of continued use of anti-CMV therapy after immune recovery and the relationship of developing immune recovery uveitis with the type of anti-CMV therapy.
Forty-three patients (64 eyes) had healed CMV retinitis and had achieved immune recovery. Thirty-one patients (48 eyes) received anti-CMV therapy after immune recovery, and 20 patients (29 eyes) developed immune recovery uveitis. Per-eye analyses revealed a 3.8-fold increase in the odds of developing immune recovery uveitis with anti-CMV therapy compared with no treatment (
P = .02). If treated with cidofovir the odds were 3.3 greater than if treated with an alternative regimen (
P = .04), 4.1 greater if treated intravenously (
P = .01), and 5.2 greater than if not treated (
P = .004). If not treated with cidofovir, a nonsignificant increase in the risk (2.4) of immune recovery uveitis was found (
P = .15). Neither the potency nor the use of implants for noncidofovir treatment was related to the risk of recovery uveitis (
P > .62).
The use of cidofovir is a primary risk factor in the subsequent development of immune recovery uveitis. Ongoing treatment of healed CMV retinitis after immune recovery does not appear to protect against the development of immune recovery uveitis. |
| doi_str_mv | 10.1016/S0002-9394(03)00335-0 |
| format | Article |
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Observational cohort study.
Data were obtained on AIDS patients with CMV retinitis followed up at the AIDS Ocular Research Unit of University of California San Diego from November 1995 to October 1999. Immune recovery was defined as CD4 count greater than 50 cells/μl for more than 3 months. Patients with immune recovery uveitis presented with vitritis, cystoid macular edema, or epiretinal membrane. Statistical analyses were conducted to determine the risk of continued use of anti-CMV therapy after immune recovery and the relationship of developing immune recovery uveitis with the type of anti-CMV therapy.
Forty-three patients (64 eyes) had healed CMV retinitis and had achieved immune recovery. Thirty-one patients (48 eyes) received anti-CMV therapy after immune recovery, and 20 patients (29 eyes) developed immune recovery uveitis. Per-eye analyses revealed a 3.8-fold increase in the odds of developing immune recovery uveitis with anti-CMV therapy compared with no treatment (
P = .02). If treated with cidofovir the odds were 3.3 greater than if treated with an alternative regimen (
P = .04), 4.1 greater if treated intravenously (
P = .01), and 5.2 greater than if not treated (
P = .004). If not treated with cidofovir, a nonsignificant increase in the risk (2.4) of immune recovery uveitis was found (
P = .15). Neither the potency nor the use of implants for noncidofovir treatment was related to the risk of recovery uveitis (
P > .62).
The use of cidofovir is a primary risk factor in the subsequent development of immune recovery uveitis. Ongoing treatment of healed CMV retinitis after immune recovery does not appear to protect against the development of immune recovery uveitis.</description><identifier>ISSN: 0002-9394</identifier><identifier>EISSN: 1879-1891</identifier><identifier>DOI: 10.1016/S0002-9394(03)00335-0</identifier><identifier>PMID: 14516810</identifier><identifier>CODEN: AJOPAA</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; AIDS-Related Opportunistic Infections - drug therapy ; AIDS-Related Opportunistic Infections - immunology ; Antiretroviral Therapy, Highly Active ; Antiviral Agents - adverse effects ; Biological and medical sciences ; CD4 Lymphocyte Count ; CD4-Positive T-Lymphocytes - immunology ; Cidofovir ; Cytomegalovirus ; Cytomegalovirus Retinitis - drug therapy ; Cytomegalovirus Retinitis - immunology ; Cytosine - adverse effects ; Cytosine - analogs & derivatives ; Drug therapy ; Drug toxicity and drugs side effects treatment ; Epiretinal Membrane - diagnosis ; Eye Diseases - diagnosis ; Female ; HIV ; Human immunodeficiency virus ; Human viral diseases ; Humans ; Incidence ; Infectious diseases ; Macular Edema - diagnosis ; Male ; Medical research ; Medical sciences ; Ophthalmology ; Organophosphonates ; Organophosphorus Compounds - adverse effects ; Pharmacology. Drug treatments ; Retinopathies ; Risk Factors ; Toxicity: eye ; Uveitis - chemically induced ; Uveitis - diagnosis ; Uveitis - epidemiology ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids ; Vitreous Body - pathology</subject><ispartof>American journal of ophthalmology, 2003-10, Vol.136 (4), p.696-702</ispartof><rights>2003 Elsevier Inc.</rights><rights>2004 INIST-CNRS</rights><rights>Copyright Elsevier Limited Oct 2003</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-acc13127556b8cb1c9f239574d4b4e13270914de7bca8328aba24f4e1e44282f3</citedby><cites>FETCH-LOGICAL-c419t-acc13127556b8cb1c9f239574d4b4e13270914de7bca8328aba24f4e1e44282f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002939403003350$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27903,27904,65309</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15167012$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14516810$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Song, Mi-Kyoung</creatorcontrib><creatorcontrib>Azen, Stanley P</creatorcontrib><creatorcontrib>Buley, Ann</creatorcontrib><creatorcontrib>Torriani, Francesca</creatorcontrib><creatorcontrib>Cheng, Lingyun</creatorcontrib><creatorcontrib>Chaidhawangul, Sunan</creatorcontrib><creatorcontrib>Ozerdem, Ugur</creatorcontrib><creatorcontrib>Scholz, Barbara</creatorcontrib><creatorcontrib>Freeman, William R</creatorcontrib><title>Effect of anti-cytomegalovirus therapy on the incidence of immune recovery uveitis in AIDS patients with healed cytomegalovirus retinitis</title><title>American journal of ophthalmology</title><addtitle>Am J Ophthalmol</addtitle><description>To determine the association between anticytomegalovirus (CMV) maintenance therapy after immune recovery and immune recovery uveitis in acquired immunodeficiency syndrome (AIDS) patients on highly active antiretroviral therapy (HAART).
Observational cohort study.
Data were obtained on AIDS patients with CMV retinitis followed up at the AIDS Ocular Research Unit of University of California San Diego from November 1995 to October 1999. Immune recovery was defined as CD4 count greater than 50 cells/μl for more than 3 months. Patients with immune recovery uveitis presented with vitritis, cystoid macular edema, or epiretinal membrane. Statistical analyses were conducted to determine the risk of continued use of anti-CMV therapy after immune recovery and the relationship of developing immune recovery uveitis with the type of anti-CMV therapy.
Forty-three patients (64 eyes) had healed CMV retinitis and had achieved immune recovery. Thirty-one patients (48 eyes) received anti-CMV therapy after immune recovery, and 20 patients (29 eyes) developed immune recovery uveitis. Per-eye analyses revealed a 3.8-fold increase in the odds of developing immune recovery uveitis with anti-CMV therapy compared with no treatment (
P = .02). If treated with cidofovir the odds were 3.3 greater than if treated with an alternative regimen (
P = .04), 4.1 greater if treated intravenously (
P = .01), and 5.2 greater than if not treated (
P = .004). If not treated with cidofovir, a nonsignificant increase in the risk (2.4) of immune recovery uveitis was found (
P = .15). Neither the potency nor the use of implants for noncidofovir treatment was related to the risk of recovery uveitis (
P > .62).
The use of cidofovir is a primary risk factor in the subsequent development of immune recovery uveitis. Ongoing treatment of healed CMV retinitis after immune recovery does not appear to protect against the development of immune recovery uveitis.</description><subject>Adult</subject><subject>AIDS-Related Opportunistic Infections - drug therapy</subject><subject>AIDS-Related Opportunistic Infections - immunology</subject><subject>Antiretroviral Therapy, Highly Active</subject><subject>Antiviral Agents - adverse effects</subject><subject>Biological and medical sciences</subject><subject>CD4 Lymphocyte Count</subject><subject>CD4-Positive T-Lymphocytes - immunology</subject><subject>Cidofovir</subject><subject>Cytomegalovirus</subject><subject>Cytomegalovirus Retinitis - drug therapy</subject><subject>Cytomegalovirus Retinitis - immunology</subject><subject>Cytosine - adverse effects</subject><subject>Cytosine - analogs & derivatives</subject><subject>Drug therapy</subject><subject>Drug toxicity and drugs side effects treatment</subject><subject>Epiretinal Membrane - diagnosis</subject><subject>Eye Diseases - diagnosis</subject><subject>Female</subject><subject>HIV</subject><subject>Human immunodeficiency virus</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infectious diseases</subject><subject>Macular Edema - diagnosis</subject><subject>Male</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Ophthalmology</subject><subject>Organophosphonates</subject><subject>Organophosphorus Compounds - adverse effects</subject><subject>Pharmacology. Drug treatments</subject><subject>Retinopathies</subject><subject>Risk Factors</subject><subject>Toxicity: eye</subject><subject>Uveitis - chemically induced</subject><subject>Uveitis - diagnosis</subject><subject>Uveitis - epidemiology</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. Aids</subject><subject>Vitreous Body - pathology</subject><issn>0002-9394</issn><issn>1879-1891</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc-KFDEQh4Mo7jj6CEpABD20ppL0n5yWZV11YcHD6jmk0xUny3RnTNIj8wi-temdwQUvnlIhX1WF70fIS2DvgUHz4ZYxxisllHzLxDvGhKgr9oisoGtVBZ2Cx2T1Fzkjz1K6K9emle1TcgayhqYDtiK_r5xDm2lw1EzZV_aQw4g_zDbsfZwTzRuMZnegYVpK6ifrB5wsLg1-HOcJaUQb9hgPdN6jzz4ViF5cf7ylO5M9TjnRXz5v6AbNFgf674KI2U9L23PyxJltwhenc02-f7r6dvmluvn6-fry4qayElSujLUggLd13fSd7cEqx4WqWznIXiII3jIFcsC2t6YTvDO94dKVF5SSd9yJNXl9nLuL4eeMKeu7MMeprNTQSNnVSrK6UPWRsjGkFNHpXfSjiQcNTC8B6PsA9GJXM6HvAyjFmrw6TZ_7EYeHrpPxArw5ASZZs3XRFKXpgStYy4AX7vzIYXGx9xh1sn4xP_giPOsh-P985Q8n9KQh</recordid><startdate>20031001</startdate><enddate>20031001</enddate><creator>Song, Mi-Kyoung</creator><creator>Azen, Stanley P</creator><creator>Buley, Ann</creator><creator>Torriani, Francesca</creator><creator>Cheng, Lingyun</creator><creator>Chaidhawangul, Sunan</creator><creator>Ozerdem, Ugur</creator><creator>Scholz, Barbara</creator><creator>Freeman, William R</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope></search><sort><creationdate>20031001</creationdate><title>Effect of anti-cytomegalovirus therapy on the incidence of immune recovery uveitis in AIDS patients with healed cytomegalovirus retinitis</title><author>Song, Mi-Kyoung ; Azen, Stanley P ; Buley, Ann ; Torriani, Francesca ; Cheng, Lingyun ; Chaidhawangul, Sunan ; Ozerdem, Ugur ; Scholz, Barbara ; Freeman, William R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c419t-acc13127556b8cb1c9f239574d4b4e13270914de7bca8328aba24f4e1e44282f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Adult</topic><topic>AIDS-Related Opportunistic Infections - drug therapy</topic><topic>AIDS-Related Opportunistic Infections - immunology</topic><topic>Antiretroviral Therapy, Highly Active</topic><topic>Antiviral Agents - adverse effects</topic><topic>Biological and medical sciences</topic><topic>CD4 Lymphocyte Count</topic><topic>CD4-Positive T-Lymphocytes - immunology</topic><topic>Cidofovir</topic><topic>Cytomegalovirus</topic><topic>Cytomegalovirus Retinitis - drug therapy</topic><topic>Cytomegalovirus Retinitis - immunology</topic><topic>Cytosine - adverse effects</topic><topic>Cytosine - analogs & derivatives</topic><topic>Drug therapy</topic><topic>Drug toxicity and drugs side effects treatment</topic><topic>Epiretinal Membrane - diagnosis</topic><topic>Eye Diseases - diagnosis</topic><topic>Female</topic><topic>HIV</topic><topic>Human immunodeficiency virus</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infectious diseases</topic><topic>Macular Edema - diagnosis</topic><topic>Male</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Ophthalmology</topic><topic>Organophosphonates</topic><topic>Organophosphorus Compounds - adverse effects</topic><topic>Pharmacology. Drug treatments</topic><topic>Retinopathies</topic><topic>Risk Factors</topic><topic>Toxicity: eye</topic><topic>Uveitis - chemically induced</topic><topic>Uveitis - diagnosis</topic><topic>Uveitis - epidemiology</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. Aids</topic><topic>Vitreous Body - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Song, Mi-Kyoung</creatorcontrib><creatorcontrib>Azen, Stanley P</creatorcontrib><creatorcontrib>Buley, Ann</creatorcontrib><creatorcontrib>Torriani, Francesca</creatorcontrib><creatorcontrib>Cheng, Lingyun</creatorcontrib><creatorcontrib>Chaidhawangul, Sunan</creatorcontrib><creatorcontrib>Ozerdem, Ugur</creatorcontrib><creatorcontrib>Scholz, Barbara</creatorcontrib><creatorcontrib>Freeman, William R</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>American journal of ophthalmology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Song, Mi-Kyoung</au><au>Azen, Stanley P</au><au>Buley, Ann</au><au>Torriani, Francesca</au><au>Cheng, Lingyun</au><au>Chaidhawangul, Sunan</au><au>Ozerdem, Ugur</au><au>Scholz, Barbara</au><au>Freeman, William R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of anti-cytomegalovirus therapy on the incidence of immune recovery uveitis in AIDS patients with healed cytomegalovirus retinitis</atitle><jtitle>American journal of ophthalmology</jtitle><addtitle>Am J Ophthalmol</addtitle><date>2003-10-01</date><risdate>2003</risdate><volume>136</volume><issue>4</issue><spage>696</spage><epage>702</epage><pages>696-702</pages><issn>0002-9394</issn><eissn>1879-1891</eissn><coden>AJOPAA</coden><abstract>To determine the association between anticytomegalovirus (CMV) maintenance therapy after immune recovery and immune recovery uveitis in acquired immunodeficiency syndrome (AIDS) patients on highly active antiretroviral therapy (HAART).
Observational cohort study.
Data were obtained on AIDS patients with CMV retinitis followed up at the AIDS Ocular Research Unit of University of California San Diego from November 1995 to October 1999. Immune recovery was defined as CD4 count greater than 50 cells/μl for more than 3 months. Patients with immune recovery uveitis presented with vitritis, cystoid macular edema, or epiretinal membrane. Statistical analyses were conducted to determine the risk of continued use of anti-CMV therapy after immune recovery and the relationship of developing immune recovery uveitis with the type of anti-CMV therapy.
Forty-three patients (64 eyes) had healed CMV retinitis and had achieved immune recovery. Thirty-one patients (48 eyes) received anti-CMV therapy after immune recovery, and 20 patients (29 eyes) developed immune recovery uveitis. Per-eye analyses revealed a 3.8-fold increase in the odds of developing immune recovery uveitis with anti-CMV therapy compared with no treatment (
P = .02). If treated with cidofovir the odds were 3.3 greater than if treated with an alternative regimen (
P = .04), 4.1 greater if treated intravenously (
P = .01), and 5.2 greater than if not treated (
P = .004). If not treated with cidofovir, a nonsignificant increase in the risk (2.4) of immune recovery uveitis was found (
P = .15). Neither the potency nor the use of implants for noncidofovir treatment was related to the risk of recovery uveitis (
P > .62).
The use of cidofovir is a primary risk factor in the subsequent development of immune recovery uveitis. Ongoing treatment of healed CMV retinitis after immune recovery does not appear to protect against the development of immune recovery uveitis.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>14516810</pmid><doi>10.1016/S0002-9394(03)00335-0</doi><tpages>7</tpages></addata></record> |
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| ispartof | American journal of ophthalmology, 2003-10, Vol.136 (4), p.696-702 |
| issn | 0002-9394 1879-1891 |
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| subjects | Adult AIDS-Related Opportunistic Infections - drug therapy AIDS-Related Opportunistic Infections - immunology Antiretroviral Therapy, Highly Active Antiviral Agents - adverse effects Biological and medical sciences CD4 Lymphocyte Count CD4-Positive T-Lymphocytes - immunology Cidofovir Cytomegalovirus Cytomegalovirus Retinitis - drug therapy Cytomegalovirus Retinitis - immunology Cytosine - adverse effects Cytosine - analogs & derivatives Drug therapy Drug toxicity and drugs side effects treatment Epiretinal Membrane - diagnosis Eye Diseases - diagnosis Female HIV Human immunodeficiency virus Human viral diseases Humans Incidence Infectious diseases Macular Edema - diagnosis Male Medical research Medical sciences Ophthalmology Organophosphonates Organophosphorus Compounds - adverse effects Pharmacology. Drug treatments Retinopathies Risk Factors Toxicity: eye Uveitis - chemically induced Uveitis - diagnosis Uveitis - epidemiology Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids Vitreous Body - pathology |
| title | Effect of anti-cytomegalovirus therapy on the incidence of immune recovery uveitis in AIDS patients with healed cytomegalovirus retinitis |
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