Immune-recovery uveiti in patient with cytomegaloviru retiniti taking highly active antiretroviral therapy

PURPOE: To invetigate the clinical feature aociated with immune recovery in human immunodeficiency viru (HIV)–infected patient with cytomegaloviru retiniti who are taking highly active antiretroviral therapy. METHOD: ixteen patient were evaluated propectively at the National Eye Intitute, Betheda, Maryland. Evaluation included a medical hitory and a complete ophthalmologic examination. The examination included bet-corrected viual acuity core meaured by mean of logarithmic chart, lit-lamp biomicrocopy, dilated retinal examination, retinal photography, and fluorecein angiography. Immune-recovery uveiti wa defined a the ocular inflammation aociated with clinical immune recovery in patient taking potent antiretroviral regimen. The ophthalmic characteritic of immune-recovery uveiti were identified, and their effect on viual acuity wa tatitically analyzed. REULT: The mean CD4+ T-lymphocyte count for the 16 patient taking highly active antiretroviral therapy at the time of evaluation wa 393 cell/μl (range, 97–1,338 cell/μl). Immune-recovery uveiti wa characterized by vitreiti and optic dik and macular edema. Clinically important complication of immune-recovery uveiti included cataract and epiretinal membrane formation. The viual acuity core were ignificantly wore in the 23 eye with cytomegaloviru retiniti (mean, 67.2 letter, 20/50) than in the nine eye without cytomegaloviru retiniti (mean, 89.8 letter, 20/16) (P < .001). Regreion analyi howed that a lower viual acuity core wa aociated with the preence of moderate to evere macular edema on fluorecein angiography and vitreou haze (P ≤ .001). CONCLUION: Immune-recovery uveiti i an important caue of viual morbidity in HIV-infected patient with cytomegaloviru retiniti in the era of highly active antiretroviral therapy. Although immune recovery aociated with highly active antiretroviral therapy ha allowed ome patient to dicontinue pecific anticytomegaloviru therapy, the rejuvenated immune repone can be aociated with ight-threatening inflammation.