Transient vitreous inflammatory reactions associated with combination antiretroviral therapy in patients with AIDS and cytomegalovirus retinitis.
OBJECTIVE
To report the observation that a transient vitreous inflammatory reaction may develop in the eyes of patients with acquired immunodeficiency syndrome (AIDS), cytomegalovirus retinitis, and an increased CD4+ T-lymphocyte count during treatment with antiretroviral therapy including a protease inhibitor.


METHODS
We reviewed the medical records of eight patients with AIDS and cytomegalovirus retinitis who developed vitreous inflammatory reactions greater than those usually seen with this disease.


RESULTS
Vitreous inflammatory reactions obscured the view of the posterior pole in all patients. No iris nodules, synechiae, glaucoma, or cystoid macular edema were observed. Six patients had unilateral cytomegalovirus retinitis, and, in each, the inflammation occurred only in the eye with cytomegalovirus retinitis. The vitreous inflammatory reactions were associated with clinically inactive cytomegalovirus retinitis in six patients, with disease reactivation in one patient, and were present at diagnosis of active disease in one patient. Cytomegalovirus retinitis has not recurred in any of these patients since their episodes of vitreous inflammation. Vitreous inflammation developed in all eight patients after a substantial increase in CD4+ T-lymphocyte counts caused by combination antiretroviral therapy. Five patients had CD4+ T-lymphocyte counts of greater than 100 cells per microl at the time the vitreous inflammatory reaction developed. No other causes of uveitis were found.


CONCLUSIONS
Patients with AIDS and cytomegalovirus retinitis may develop transient intraocular inflammation associated with combination antiretroviral therapy. We believe that this inflammation reflects an improved immune response against cytomegalovirus.
Zegans
M E
ME
Francis I. Proctor Foundation, Department of Ophthalmology, University of California, San Francisco 94122, USA.
Walton
R C
RC
Holland
G N
GN
O'Donnell
J J
JJ
Jacobson
M A
MA
Margolis
T P
TP
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000276:immunology; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy* / Q000276:immunology; D004359:Drug Therapy, Combination; D005128:Eye Diseases / Q000139:chemically induced; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D012008:Recurrence; D015866:Uveitis, Posterior / Q000139:chemically induced*; D014822:Vitreous Body / Q000187:drug effects*
D019380:Anti-HIV Agents