Immune recovery uveitis in HIV patients with cytomegalovirus retinitis in the era of HAART therapy-a 5-year study from Singapore.
BACKGROUND
The aim of this study is to analyse the clinical features of HIV patients with cytomegalovirus retinitis (CMVR) developing immune recovery uveitis (IRU) while on highly active antiretroviral therapy (HAART) and to identify the risk factors, visual outcomes and complications of IRU.


RESULTS
Majority (n = 26, 86.7 %) of patients were male, with 76.7 % (n = 23) of patients having bilateral disease. Twenty-seven eyes (50.9 %) had both anterior uveitis and vitritis. The median CD4 at IRU was 210 cells/μL (IQR 140-279), with 86.7 % having CD4 >100 cells/μL. The median duration from initiation of HAART to IRU was significantly different between those <50 years old (median 763 days, IQR 174-1872 days) and those ≥50 years old (median 161 days, IQR 84.5-278 days). Fourteen eyes (26.4 %) had loss of one or more Snellen lines visual acuity at 6 months while the rest maintained or improved vision. Complications developed in 21 eyes, with cataract (66.7 %), glaucoma and ocular hypertension (33.3 %) being the most common. The risk of complications was associated with the absolute difference in CD4 counts at IRU and at HAART commencement (p = 0.041). Age was also negatively associated with the duration from HAART to IRU (p = 0.005, Spearman's rho coefficient = -0.503).


CONCLUSIONS
It is common to have both anterior uveitis and vitritis in IRU. There was a positive association between the increase in CD4 from HIV to IRU diagnoses and the risk of developing complications. Younger patients appeared to develop IRU later than older patients after HAART, suggesting that long-term follow-ups are essential for these patients.
National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore. tunhang.yeo@gmail.com.
Tun Hang
http://orcid.org/0000-0001-9786-8356
TH
Yeo
National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore.
Tun Kuan
TK
Yeo
National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore.
Elizabeth P
EP
Wong
National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore.
Rupesh
R
Agrawal
National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore.|Eagle Eye Centre, Singapore, Singapore.
Stephen C
SC
Teoh
Cytomegalovirus retinitis; Highly active antiretroviral therapy; Human immunodeficiency virus; Immune reconstitution inflammatory syndrome; Immune recovery uveitis