摘要巨细胞病毒(Cytomegalovirus,CMV)视网膜炎(Cytomegalovirus retinitis,CMVR)是AIDS患者视力损失的常见原因.结合浙江区域特点,制订针对AIDS患者合并CMVR的诊治共识,有助于提高临床医师对CMVR的综合诊治能力,降低患者视力伤失风险,提高患者生活质量.本共识建议:(1)CD4 +T淋巴细胞数＜100个／μL的AIDS患者,尤其是＜50个／μL的患者,应定期进行眼底检查,经验丰富的眼科医师行眼底镜检查是确诊CMVR的主要手段;(2)发生CMVR的AIDS患者,要积极选用更昔洛韦、膦甲酸钠、缬更昔洛韦进行抗CMV治疗,2周内启动高效抗反转录病毒治疗;(3)中央型视网膜病变者需联合玻璃体腔内注射进行抗CMV治疗;(4)无眼底活动性病变且CD4 +T淋巴细胞增长至100个／μL以上并持续3～6个月的患者,可考虑停止抗CMV治疗;(5)停止抗CMV治疗后应规律行眼底镜检查,监测CMVR是否复发,如出现明显的眼底活动性病变或者CD4+T淋巴细胞下降至100个／μL以下,应再次启动抗CMV治疗.

abstractsCytomegalovirus retinitis ( CMVR) is a common cause leading to visual loss in AIDS patients.In order to better understand and manage this disease , to reduce the risk of visual loss and improve the quality of life of patients, the Zhejiang expert consensus on diagnosis and treatment of CMVR in AIDS patients has been developed.The consensus suggests that AIDS patients with CD 4 + T-cell count ＜100 cells／μL, especially those below 50 cells／μL, should receive regular fundus examinations by experienced ophthalmologists ; patients diagnosed with CMVR should be treated with ganciclovir , foscarnet or valganciclovir, and the highly active antiretroviral therapy should be initiated within two weeks ; additional intravitreal injection of ganciclovir or foscarnet is recommend for patients with immediate sight -threatening lesions.In patients with inactive lesions and with CD4 +T-cell counts ＞100 cells／μL lasting for 3 to 6 months, the maintenance therapy can be discontinued and the routine ophthalmology should be followed -up to detect the occurrence of CMVR or immune reconstitution uveitis ( IRU).The anti-CMV therapy should be considered in patients with re-activated fundus lesions or with decreasing CD 4 +T-cells to ＜100 cells／μL.