[The role of HIV associated eye changes in the time of HAART (highly active antiretroviral therapy].
Choice of an appropriate treatment strategy in the handling of HIV infection has become problematical, owing to the very serious side effects that sometimes develop in conjunction with antiretroviral combination therapy (HAART). Indeed, the severity of these affections can assume such a magnitude as to render an abatement or even the interruption of treatment imperative in a not inconsiderable proportion of patients. In such individuals, HIV-associated opportunistic diseases thus constitute a major concern. As regards the ocular system, three diseases are regularly encountered: HIV-associated retinal microangiopathy, cytomegalovirus (CMV)-retinitis and immune-recovery uveitis, the latter being a recently recognized condition which is manifested after immune reconstitution in patients with a history of viral retinitis. Retinal microangiopathy assumes significance in that it signals uncontrolled replication of the retrovirus. Viral retinitis hallmarks an actual breakdown of the functional immune response and may be observed in patients undergoing HAART even if their CD4 counts are above 100 per microliter. The treatment of this condition is crucial for the prolongation of survival and in so far as its manifestation renders an estimation of when systematic recurrence prophylaxis should be interrupted extremely difficult. Furthermore, reactivated retinitis is sometimes difficult to distinguish from immune-recovery uveitis--an immune restoration reaction which is probably directed against persisting CMV antigens. This circumstance may account for the impaired visual function attributable to chronic macular edema and epiretinal membrane formation.
Garweg
J G
JG
Universitäts-Augenklinik, Inselspital, Bern. justus.garweg@insel.ch
Barloggio
A
A
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy*; D023241:Antiretroviral Therapy, Highly Active; D017726:Cytomegalovirus Retinitis / Q000175:diagnosis / Q000188:drug therapy*; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D012008:Recurrence; D012164:Retinal Diseases / Q000175:diagnosis / Q000188:drug therapy*; D012307:Risk Factors; D014605:Uveitis / Q000175:diagnosis / Q000188:drug therapy*
Die Rolle HIV-assoziierter Augenveränderungen im Zeitalter von HAART (hochaktive antiretrovirale Therapie).