[Anterior segment involvement in HIV-related eye disease after the commencement of highly active antiretroviral therapy (HAART)].
The clinical picture of HIV-associated eye disease has changed dramatically since the introduction of highly active antiretroviral chemotherapy (HAART). As a consequence of the marked reconstitution of immune function and the control of retroviral replication, thereby effected, the clinical manifestations of infectious eye disease are not so patent. Although direct infectious destruction of tissue is less severe, inflammatory infiltration is augmented, and this gives rise to a situation that is open to misinterpretation. Furthermore, several completely new disease entities have been described. One of these is the so-called immune-recovery uveitis, which involves mainly the anterior uvea and vitreous, and is not uncommonly associated with a marked disturbance of visual function. Another group of new diseases has been attributed to the toxic effects of drugs, i.e. of Cidofovir and Rifabutin. In both instances, a principally anterior form of uveitis develops, which is characterized by a discrepancy between clinical symptoms and morphological changes; the former condition is distinguished by severe pain, and the latter by marked inflammation. This article describes the clinical pictures characterizing these new affections of the anterior segment, postulates on the possible causes of the seemingly paradoxical clinical, morphological and immunological situations sometimes presented by them, and comments on recommended treatment strategies. The information furnished is designed to help the clinical practitioner in making his/her diagnostic and therapeutic decisions.
Garweg
J G
JG
Univ.-Augenklinik, Inselspital, Bern. justus.garweg@insel.ch
D017088:AIDS-Related Opportunistic Infections / Q000139:chemically induced / Q000209:etiology* / Q000382:microbiology; D000818:Animals; D019380:Anti-HIV Agents / Q000009:adverse effects*; D000904:Antibiotics, Antitubercular / Q000009:adverse effects*; D000077404:Cidofovir; D003596:Cytosine / Q000009:adverse effects / Q000031:analogs & derivatives; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005128:Eye Diseases / Q000139:chemically induced / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000009:adverse effects; D017828:Rifabutin / Q000009:adverse effects; D014605:Uveitis / Q000209:etiology
D019380:Anti-HIV Agents; D000904:Antibiotics, Antitubercular; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D017828:Rifabutin; D003596:Cytosine; D000077404:Cidofovir