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July 2, 2026Open Access

Cytomegalovirus Retinitis in Newly Diagnosed Advanced HIV Infection: A Three-Case Series Emphasizing Multidisciplinary Infection Screening

SYShintaro YatakaTokyo Medical University KTKinya TsubotaTokyo Medical University KWKei WakatsukiTokyo Medical University

Key Points

This study aims to highlight CMV retinitis in newly diagnosed advanced HIV infection and the need for comprehensive screening.
Retrospective review of three male patients with HIV-associated CMV retinitis at a tertiary center.
Summary included clinical findings, CD4 counts, HIV-RNA levels, and treatment outcomes.
Focus on the importance of multidisciplinary management and broadened infection screening.
All patients exhibited CD4 counts between 46 and 141 cells/µL, indicating severe immunodeficiency.
CMV-DNA was found in the aqueous humor for all, confirming the infection presence.
Significant coinfections were noted: all had syphilis and hepatitis B, with additional cases of oral candidiasis and tuberculosis.

Abstract

Background/Objectives: Cytomegalovirus (CMV) retinitis remains a significant opportunistic infection in patients with advanced human immunodeficiency virus (HIV) infection, particularly with late HIV diagnoses. This three-case series aimed to describe HIV-associated CMV retinitis in newly diagnosed advanced HIV infection with documented concurrent and/or prior infectious conditions, and to highlight the importance of bord systemic screening and multidisciplinary management. Methods: We retrospectively reviewed three male patients diagnosed with HIV-associated CMV retinitis at a tertiary ophthalmology referral center. Clinical findings, CD4-positive T-cell counts, HIV-RNA levels, aqueous humor CMV-DNA results, systemic infectious conditions, treatment and ocular outcomes were summarized. Results: All patients had marked cellular immunodeficiency, with CD4-positive T-cell counts ranging from 46 to 141 cells/µL, and CMV-DNA was detected in aqueous humor in all cases. The infectious burden was substantial: all three patients had syphilis and hepatitis B virus infection, two had oral candidiasis, and individual patients had chlamydia infection, tuberculosis, amebic colitis, or a history of herpes zoster. One patient was initially suspected of having syphilitic uveitis, which illustrates how coinfections may obscure the diagnosis of CMV retinitis. Retinal detachment occurred in two cases and was surgically repaired with anatomical recovery. Conclusions: These cases emphasize that CMV retinitis in newly diagnosed advanced HIV infection should prompt broad infection screening and multidisciplinary evaluation, particularly in the setting of delayed HIV diagnosis and severe immunosuppression. Comprehensive screening for opportunistic and sexually transmitted infections, prompt ocular virological confirmation, and multidisciplinary management are essential in patients with HIV-associated CMV retinitis.

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