Immune recovery uveitis in AIDS patients with cytomegalovirus retinitis treated with highly active antiretroviral therapy in Venezuela.
OBJECTIVE
To determine the characteristics of immune recovery uveitis (IRU) in acquired immunodeficiency syndrome (AIDS) patients with inactive cytomegalovirus (CMV) retinitis who responded to highly active antiretroviral therapy (HAART) in a Venezuelan population.


METHODS
We examined 34 patients (50 eyes) with AIDS (HAART responders) and healed CMV retinitis. Patients were observed for a median of 19.3 months following an increase in the CD4 cell count. Ten eyes were treated with sub-Tenon space corticosteroid injections. An age-matched control group of patients with healed CMV retinitis who did not have IRU (30 eyes of 20 patients) was included to compare CMV surface area and complications.


RESULTS
We found that 12 (37.5%) of 32 HAART responders developed IRU (18 eyes). The clinical findings of these 18 eyes with IRU are presented. The clinical spectrum of inflammation included vitritis, macular edema, epiretinal membranes, anterior uveitis, macular hole, retinal detachment with proliferative vitreoretinopathy, and cataract. Eyes with IRU had a mean CMV surface area of 31.7%. However, eyes without IRU (control group) had a mean CMV surface area of 35% (P = 0.41). Periocular treatment resulted in vision improvement (in 90% of eyes) without reactivation of retinitis.


CONCLUSIONS
Symptomatic IRU developed in a significant number of patients with CMV retinitis following successful HAART in a Venezuelan population. CMV surface area does not seem to be a risk factor for the development of IRU. Eyes with IRU respond favorably to antiinflammatory therapy without reactivation of retinitis.
Arevalo
J Fernando
JF
Retina and Vitreous Service, Clinica Oftalmologica Centro Caracas, Centro Caracas PH-1, Av. Panteon, San Bernardino, Caracas 1010, Venezuela. areval1@telcel.net.ve
Mendoza
Aristides J
AJ
Ferretti
Yolanda
Y
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D017726:Cytomegalovirus Retinitis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D005260:Female; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D014605:Uveitis / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D014687:Venezuela; D014792:Visual Acuity
D000893:Anti-Inflammatory Agents; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors