Antiretrovirals
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Antiretrovirals Immune recovery uveitis in patients with inactive cytomegalovirus retinitis: 10 case reports
In a retrospective study, 10 HIV-positive men with inactive cytomegalovirus retinitis developed immune recovery uveitis [see table], following treatment with HAART. Nine of the 10 men aged 29 to 56 years (average age 40.3 years) had previously received ganciclovir. All of the men initiated HAART [drugs and dosages not stated] between 1995 and 2002. They subsequently developed visual loss with cystoid retinal oedema (five patients), epiretinal membrane (ERM; two patients), iritis (seven patients) and vitritis (10 patients). Six patients had cataracts (including four patients with a posterior subcapsular cataract (PSC), one with an anterior subcapsular cataract (ASC) and one patient with both), and two patients had rhegmatogenous retinal detachment (RD) [duration of therapy to reaction onset not stated]. Visual acuity was between 0.01 and 0.5. The reactions lasted between 1 and 4 months.
Patient and reaction characteristics Patient/ age (yrs) 1 / 50 2 / 56 3 / 35 4 / 49 5 / 33 6 / 29 7 / 42 8 / 36 9 / 36 10 / 37
Reaction
Treatment
Iritis/vitritis/ASC/ERM Iritis/vitritis/PSC Iritis/vitritis/ASC+ PSC/retinal oedema Iritis/vitritis/PSC Iritis/vitritis/retinal oedema Iritis/vitritis/RD/PSC Vitritis/ERM/retinal oedema Iritis/vitritis/retinal oedema/total RD Vitritis/PSC Vitritis/retinal oedema
Steroid eye drops Steroid eye drops NSAID/steroid eye drops Sulfasalazine/NSAID NSAID/steroid eye drops NSAID Triamcinolone NSAID Steroid eye drops Triamcinolone
Pars plana vitrectomy was conducted in patients 6 and 8. Patients 1 and 9 underwent cataract surgery. Patients 7 and 10 received triamcinolone [Kenacort]. Five men received topical steroid eye drops and five men received NSAIDs. Patient 4 received sulfasalazine [Salazopyrin]. Follow-up was between 7 and 100 months. In seven of the men, some recovery in visual acuity was observed, in patients 2 and 5 there was no change, and in patient 7 visual acuity worsened. Author comment: "[I]t has been postulated that [immune recovery uveitis] may represent a subclinical viral replication or an immunologic response to residual viral antigen in the eye." Lin Y-C, et al. Cytomegalovirus retinitis and immune recovery uveitis in AIDS patients treated with highly active antiretroviral therapy in Taiwanese. Ocular Immunology and Inflammation 16: 83-87, No. 3, May-Jun 2008 801117107 Taiwan
0114-9954/10/1211-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 19 Jul 2008 No. 1211
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