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CMV Retinitis — SCE Infectious Diseases MCQ

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HardHIV MedicineCMV RetinitisSCE Infectious Diseases

A 55-year-old man with HIV (CD4 150) presents with progressive painless visual loss in the left eye. Fundoscopy shows a peripheral area of retinal whitening with scattered haemorrhages advancing towards the macula. CD4 count is 35 cells/µL. He is not on ART. In addition to systemic IV Ganciclovir, what ophthalmic intervention may be needed to protect the macula?

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Correct answer: B — Intravitreal Ganciclovir or Foscarnet injection for immediate-sight-threatening CMV retinitis

When CMV retinitis is immediately sight-threatening (advancing toward the macula or optic disc — zone 1 disease), intravitreal antiviral injection (Ganciclovir 2 mg or Foscarnet 2.4 mg) provides rapid local drug delivery while systemic therapy takes effect. This dual approach is recommended by BHIVA and ophthalmology guidelines. Systemic therapy alone may not achieve adequate intraocular concentrations quickly enough to halt retinal destruction at the macula. ART must also be initiated promptly.

Reference: BHIVA 2022 – OI guidelines; AAO 2020 – CMV retinitis management