Immune-recovery uveitis in patients with cytomegalovirus retinitis taking highly active antiretroviral therapy.
OBJECTIVE
To investigate the clinical features associated with immune recovery in human immunodeficiency virus (HIV)-infected patients with cytomegalovirus retinitis who are taking highly active antiretroviral therapy.


METHODS
Sixteen patients were evaluated prospectively at the National Eye Institute, Bethesda, Maryland. Evaluation included a medical history and a complete ophthalmologic examination. The examination included best-corrected visual acuity score measured by means of logarithmic charts, slit-lamp biomicroscopy, dilated retinal examination, retinal photography, and fluorescein angiography. Immune-recovery uveitis was defined as the ocular inflammation associated with clinical immune recovery in patients taking potent antiretroviral regimens. The ophthalmic characteristics of immune-recovery uveitis were identified, and their effect on visual acuity was statistically analyzed.


RESULTS
The mean CD4+ T-lymphocyte count for the 16 patients taking highly active antiretroviral therapy at the time of evaluation was 393 cells/microl (range, 97-1,338 cells/microl). Immune-recovery uveitis was characterized by vitreitis and optic disk and macular edema. Clinically important complications of immune-recovery uveitis included cataract and epiretinal membrane formation. The visual acuity scores were significantly worse in the 23 eyes with cytomegalovirus retinitis (mean, 67.2 letters, 20/50) than in the nine eyes without cytomegalovirus retinitis (mean, 89.8 letters, 20/16) (P <.001). Regression analysis showed that a lower visual acuity score was associated with the presence of moderate to severe macular edema on fluorescein angiography and vitreous haze (P < or =. 001).


CONCLUSIONS
Immune-recovery uveitis is an important cause of visual morbidity in HIV-infected patients with cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Although immune recovery associated with highly active antiretroviral therapy has allowed some patients to discontinue specific anticytomegalovirus therapy, the rejuvenated immune response can be associated with sight-threatening inflammation.
Robinson
M R
MR
National Institute of Health, Bethesda, Maryland 20892-1863, USA. mrobin@Box-m.nih.gov
Reed
G
G
Csaky
K G
KG
Polis
M A
MA
Whitcup
S M
SM
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000502:physiology*; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D005128:Eye Diseases / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D007107:Immune System / Q000502:physiology; D008269:Macular Edema / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D008875:Middle Aged; D010211:Papilledema / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D011446:Prospective Studies; D014605:Uveitis / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D014792:Visual Acuity; D014822:Vitreous Body / Q000187:drug effects / Q000276:immunology / Q000821:virology
D000998:Antiviral Agents