A Case of Proliferative Diabetic Retinopathy with HIV Infection in Which HAART Possibly Influenced the Prognosis of Visual Function

Abstract

Background: We report on a patient with proliferative diabetic retinopathy (PDR) and human immunodeficiency virus (HIV) infection who exhibited extremely active PDR followed by a rapid onset of blindness in the right eye. The progression of visual disturbance in the patient’s left eye was slowed after starting highly active anti-retroviral therapy (HAART), and vision in that eye was rescued after vitrectomy. Case Report: A 72-year-old male developed pneumocystis carinii pneumonia stemming from an HIV infection and began HAART at the Department of Hematology, Osaka Medical College, Takatsuki City, Japan. Prior to HAART, the patient had shown rapidly progressing retinopathy in the right eye accompanied by vitreous hemorrhage, tractional retinal detachment, and neovascular glaucoma, ultimately leading to early-onset blindness. After starting HAART, the progression of the retinopathy in the left eye became slower compared to the right eye, with corrected visual acuity improving to 0.6 after vitrectomy, despite being accompanied by vitreous hemorrhage. The patient’s overall condition has remained stable following the operation, and the condition of the ocular fundus in the left eye has also settled. Conclusion: Significant differences were found in the progression rate of PDR with HIV infection between before and after starting HAART. Our findings suggest that early administration of HAART to HIV patients with diabetic retinopathy is crucial for maintaining visual function.

Remodeling of Retinal Architecture in Diabetic Retinopathy: Disruption of Ocular Physiology and Visual Functions by Inflammatory Gene Products and Pyroptosis

“…A concurrent infection and the subsequent mounting of an immune along with existing inflammation in diabetics can further activate additional pro-inflammatory pathways. These can potentially further disturb the homeostatic balance in the eyes ( Joshi et al, 1999 ; Casqueiro et al, 2012 ; Kitagaki et al, 2016 ; Heller et al, 2017 ). This heightened immune reaction, in the long run, plays havoc with the host’s cellular functions.…”

Human immunodeficiency virus retinopathy with presumed cytomegalovirus retinitis with macular oedema in a diabetic

“…Retinal microvasculopathy is the most common ocular manifestation of AIDS, and clinical findings include retinal nerve fibre layer infarcts, intraretinal haemorrhages and microaneurysms that are very similar to those of DR 11. When these conditions coexist, it is challenging to determine the exact cause of the retinal findings or it could be attributed to both diseases 12 13. Coexistence of HIV retinopathy/CMV retinitis with DR in the same patient is uncommon.…”