Risk of immune recovery uveitis in patients with AIDS and cytomegalovirus retinitis.
OBJECTIVE
To evaluate the prevalence of and risk factors for immune recovery uveitis (IRU) in eyes of patients with AIDS and cytomegalovirus (CMV) retinitis.


METHODS
Enrollment data from a 19-clinical center cohort study.


METHODS
Three hundred seventy-four patients with AIDS and CMV retinitis affecting 539 eyes.


METHODS
Patients with AIDS were enrolled at 19 United States AIDS ophthalmology clinics. Data were collected by interview, review of medical records, ophthalmic examination, and phlebotomy.


METHODS
Immune recovery uveitis.


RESULTS
Thirty-six patients (9.6%) were diagnosed with IRU involving 50 eyes. The CD4+ T-cell count of 31 of these had risen by > or =50 cells per microliter above nadir to a level > or = 100 cells per microliter (immune recovery), making up 17.6% of the patients known to have immune recovery after diagnosis of CMV retinitis (95% confidence interval, 12.3%-24.1%). No patients with IRU were observed to have active retinitis or detectable CMV DNA in peripheral blood (P<0.001 and P<0.001 with respect to patients without IRU). Other factors associated with IRU were > or =25% retinal area (odds ratio [OR], 2.72; P = 0.014) or posterior pole involvement with CMV retinitis (odds ratio, 0.43; P = 0.039), treatment with intravitreous injection of cidofovir (OR, 10.6 with respect to eyes never exposed to intravitreous or IV cidofovir; P<0.001), and male gender (OR, 0.26; P = 0.012). More eyes with IRU had visual acuity (VA) of 20/50 or worse (38.0% vs. 26.3%, P = 0.077) relative to eyes without IRU, but the proportions with VA of 20/200 or worse were similar (14.0% vs. 13.8%, P = 0.96). Eyes with IRU more commonly had cystoid macular edema (CME) (45.5% vs. 3.7%, P<0.001) and epiretinal membrane (48.9% vs. 13.3%, P<0.001) than eyes without IRU.


CONCLUSIONS
Among eyes of patients with immune recovery, the prevalence of IRU is substantial. Eyes with IRU have a high risk of additional morbidity over and above that seen with CMV retinitis, with several-fold higher risk of CME and epiretinal membrane. Large CMV lesions and use of intravitreous cidofovir are risk factors for IRU.
Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. john.kempen@uphs.upenn.edu
John H
JH
Kempen
Yuan-I
YI
Min
William R
WR
Freeman
Gary N
GN
Holland
Dorothy N
DN
Friedberg
Douglas T
DT
Dieterich
Douglas A
DA
Jabs
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D000077404:Cidofovir; D003430:Cross-Sectional Studies; D017726:Cytomegalovirus Retinitis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D063065:Organophosphonates / Q000627:therapeutic use; D015995:Prevalence; D012307:Risk Factors; D015866:Uveitis, Posterior / Q000453:epidemiology / Q000209:etiology*; D014792:Visual Acuity; D014822:Vitreous Body
D000998:Antiviral Agents; D063065:Organophosphonates; D003596:Cytosine; D000077404:Cidofovir