Antiviral therapy for cytomegalovirus retinitis: A systematic review and meta-analysis

Cytomegalovirus retinitis (CMVR) is a significant cause of blindness in patients with advanced acquired immunodeficiency syndrome (AIDS). There are no established guidelines for its treatment, resulting in varied antiviral approaches. We pooled data from 59 studies (4501 patients) to evaluate treatment variations and outcomes (CRD42022321088). Overall pooled estimates showed visual acuity improvement at 18 % (95 % CI: 7-41 %), inflammation resolution at 90 % (95 % CI: 81-95 %), retinal detachment at 11 % (95 % CI: 8-14 %), and recurrence at 19 % (95 % CI: 11-31 %). The main antiviral treatment approaches identified were: (1) intravenous antivirals alone in 33 studies, (2) intravitreal antivirals alone in 26 studies, (3) oral antivirals alone in 3 studies, and (4) a combination of systemic (oral or intravenous[IV]) and intravitreal antivirals in 7 studies, with varying schemes and durations. Ganciclovir was the predominant antiviral, with intravenous administration being the most reported (in 23 studies), followed by intravitreal administration (in 20 studies). While visual acuity improvement was comparable, inflammation resolution tended to be higher with intravitreal than with IV antivirals, though not statistically significant (88 %, 95 % CI: 69-96 % vs 75 %, 95 % CI: 35-94 %, p = 0.38). Retinitis progression rate for IV ganciclovir was lower than for those without ganciclovir. Inflammation recurrence was significantly lower in antiretroviral (ART)-treated compared to non-ART-treated HIV/AIDS patients (10 % (95 % CI: 4-20 %) vs 33 % (95 % CI: 19-50 %), p < 0.01). Neutropenia, particularly with ganciclovir, was the most reported adverse effect (up to 50 %).