Chronic multifocal retinal infiltrates in patients infected with human immunodeficiency virus.
OBJECTIVE
To describe the clinical features of a disorder characterized by chronic multifocal retinal infiltrates and uveitis in individuals with human immunodeficiency virus (HIV) disease.


METHODS
We reviewed the medical records of HIV-infected patients with multifocal retinal infiltrates of unknown cause seen by investigators at four institutions. The following data were collected: demographic characteristics, presenting signs and symptoms, laboratory test results, and course of disease.


RESULTS
We identified 26 HIV-infected patients (50 involved eyes) with this syndrome. Median CD4+ T-lymphocyte count at presentation was 272 per microl (range, 7 to 2,118 per microl). The most common presenting symptom was floaters. Median visual acuity of involved eyes at presentation was 20/20 (range, 20/15 to 20/100) and remained stable (median, 20/20; range, 20/15 to 20/70) after a median follow-up period of 9 months (range, 0 to 110 months). Typical retinal lesions were gray-white or yellow, irregular in shape, and less than 200 microm in greatest dimension. All were located in the midperiphery or anterior retina and enlarged slowly or remained static in size. Mild to moderate anterior chamber or vitreous humor inflammatory cells were present in 47 of 50 eyes (26 of 26 patients). Retinal lesions possibly responded to zidovudine but not to acyclovir or ganciclovir. Anterior chamber and vitreous humor inflammatory reactions responded to topical or periocular injections of corticosteroid.


CONCLUSIONS
Uveitis with chronic multifocal retinal infiltrates is a distinct clinical entity of unknown cause that occurs in HIV-infected patients. Retinal lesions may respond to antiretroviral therapy. Visual prognosis is good.
Levinson
R D
RD
UCLA Ocular Inflammatory Disease Center, the Jules Stein Eye Institute, and Department of Ophthalmology, University of California, Los Angeles, School of Medicine, 90095-7003, USA.
Vann
R
R
Davis
J L
JL
Friedberg
D N
DN
Tufail
A
A
Terry
B T
BT
Lindley
J I
JI
Holland
G N
GN
D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D002908:Chronic Disease; D005654:Fundus Oculi; D015774:Ganciclovir / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012164:Retinal Diseases / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D013577:Syndrome; D014605:Uveitis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D014792:Visual Acuity; D015215:Zidovudine / Q000627:therapeutic use
D019380:Anti-HIV Agents; D015215:Zidovudine; D015774:Ganciclovir; D000212:Acyclovir