ORIGINAL ARTICLE Clinical Features and CD4+ T Cells Count in AIDS Patients with CMV Retinitis: Correlation with Mortality Rupesh Agrawal, FRCS a,b , Dinesh V. Gunasekeran, MBBS a , Yanping Xu, MMed c , Yee-Sin Leo, MD d,e , Oon T. Ng, MD d , Chen Seong Wong, MD d , Ilaria Testi, MS b , Jianbin Ding, MBBS student f , Imrana Banu, BSc d , and Stephen C. Teoh, FRCS g a National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore; b Moorfields Eye Hospital, National Health Service Foundation Trust, London, UK; c Department of Ophthalmology, Ng Teng Fong Hospital, Singapore, Singapore; d National Centre for Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore; e Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; f Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; g Eagle Eye Center, Gleneagles Hospital, Singapore, Singapore ABSTRACT Purpose: To explore the all-cause mortality in patients with acquired immune deficiency syndrome (AIDS) and Cytomegalovirus (CMV) retinitis. Methods: A retrospective cohort study of patients with CMV retinitis (CMVR) presented to a tertiary referral center in Singapore from January 1, 2004, through December 31, 2015. Results: A total of 144 patients were studied (87 survived, 11 lost to follow up, 46 died). Patients with bilateral CMVR and six-month follow up CD4 + T cell count < 50 cells/mm 3 have shorter time to mortality, compared to patients with CD4 + T cell count > 50 cells/mm 3 (p < .001) and unilateral disease (p = .043). Baseline CD4 + T cell count, size and zone of initial primary retinitis lesions, recurrences of retinitis, and timing of combined antiretroviral therapy (cART) are not significantly associated with mortality. Conclusion: Bilateral ocular involvement and lack of immune recovery in patients with AIDS and CMVR are associated with shorter survival time. ARTICLE HISTORY Received 13 June 2019 Revised 7 May 2020 Accepted 17 May 2020 KEYWORDS Cytomegalovirus (CMV); retinitis; acquired immune deficiency syndrome (AIDS); CD4+ T cells count; mortality; combined antiretroviral therapy (cART); immune recovery Cytomegalovirus (CMV) retinitis is the most common opportu- nistic ocular infection in patients with acquired immune defi- ciency syndrome (AIDS) and CD4 + T cell count <50 cells/ mm 3.1–6 The incidence of CMV retinitis (CMVR) has decreased by 80–90% since the development of combined antiretroviral therapy (cART), which controls the replication of the human immunodeficiency virus (HIV) and induces immune restoration, evident from increased CD4 + T cell count. 7,8 CMVR is reported in approximately 20–40% of HIV posi- tive patients and is the most common (90%) cause of uni- lateral or bilateral blindness. 5–7 The most significant predictor for the development of CMVR is a CD4+ count of less than 50 cells/μL. 7 The AIDS pandemic has met with a forceful global response. AIDS-related mortality has fallen by 50% between 2000 and 2018, with 770,000 deaths in 2018. 9,10 New HIV infections have been reduced by 40% since the peak in 1997. In 2018, around 1.7 million [1.4 million–2.3 million] were newly infected with HIV, compared to 2.9 million [2.3 million–3.8 million] in 1997. More than 95% of new HIV infections occurred in Eastern Europe and Central Asia. 10 These regions represent a reservoir susceptible to CMVR. This is a continuation of the earlier report on the epide- miological study of CMVR in HIV patients at our infectious disease center in Singapore. 11 This study aims to examine the mortality of patients with AIDS and CMVR and its correlation with CD4 + T cell count, as well as clinical features that may potentially be related to decreased survival time. Methods We conducted a retrospective review of consecutive AIDS patients with CMVR that presented to the Communicable Disease Center (CDC) and a tertiary referral eye care center in Singapore, from January 1, 2004, through December 31, 2015. This study was approved by the Institutional Review Board and adhered to the tenets outlined in the Declaration of Helsinki. Patients were referred for ocular symptoms or based on low CD4 + T cell count (<50 cells/mm 3 ). Analysis of medical records was performed. Information including patient demo- graphics, baseline clinical features, investigations, treatment, and recurrences was collected. All patients were reviewed by a uveitis specialist. The inclusion criteria were: (1) clinical diagnosis of CMVR and (2) HIV infection confirmed by Western Blot (Diagnostic Biotechnology HIV Blot 2.2; MP Biomedicals, Irvine, California, USA). CONTACT Rupesh Agrawal rupesh_agrawal@ttsh.com.sg Ophthalmologist, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore 308433, Singapore; Stephen C. Teoh Eagle Eye Center, Gleneagles Hospital, Singapore, Singapore OCULAR IMMUNOLOGY AND INFLAMMATION https://doi.org/10.1080/09273948.2020.1772312 © 2020 Taylor & Francis Group, LLC