Fri0582 non-Infectious Uveitis as a Manifestation of the Immune Reconstitution Inflammatory Syndromein Patients Infected by Hiv

Abstract

BackgroundImmune reconstitution inflammatory syndrome (IRIS) is a paradoxical clinical worsening of an already known condition or the new onset of an inflammatory manifestation that is presumably related with the immune reconstitution after starting highly active anti-retroviral therapy (HAART) in patients infected by the human immunodeficiency virus (HIV).ObjectivesThe aim of this study is to describe the clinical characteristics, presentation and response to immunosuppressive treatment in patients with uveitis secondary to ocular IRIS in our cohort of patients infected by HIV.MethodsRetrospective review of clinical charts of patients diagnosed with HIV and non-infectious uveitis. Data collected included: demographics, anatomic classification of the uveitis, phenotypic diagnosis of the uveitis, other systemic immune-mediated disorders (IMD), time from HIV diagnosis to uveitis, CD4 count, viral load, treatment and complications of treatment and time of follow-up.ResultsNine-teen patients (17 males) were included in the study. The mean age at the time of HIV diagnosis was 35.4±9.6 years. The time lag between HIV diagnosis and the onset of uveitis was 9±8.9 years. Mean CD4 count was 649±292 cells/ml, while the viral load was undetectable in 13 out of 17 cases. In 2 patients, there were a worsening of a previous IMD and in 6 patients another IMD was diagnosed prior to or concurring with the uveitis diagnosis (3 cases of reactive arthritis). The most common anatomic classification of the uveitis was anterior (13 cases). The use of immunosuppressive therapies to control either the ocular syndrome or the additional IMD was necessary in 6 patients (including biologics in 4 cases) during the follow-up. Only one patient had a complication of the immunosuppressive treatment. The mean follow-up was 43.8 months (range: 0.6 -115.7).ConclusionNon-infectious uveitis could be the first manifestation of immune-mediated systemic disease in patients with well-controlled HIV infection. Immunosuppression appeared to be a safe therapeutic option in our cohort of patients.References[1] Shelburne SA, 3rd, Hamill RJ, Rodriguez-Barradas MC, et al. Immune reconstitution inflammatory syndrome: emergence of a unique syndrome during highly active antiretroviral therapy. Medicine (Baltimore)2002;81(3):213-27. [published Online First: 2002/05/09][2] Murdoch DM, Venter WD, Van Rie A, et al. Immune reconstitution inflammatory syndrome (IRIS): review of common infectious manifestations and treatment options. AIDS Res Ther2007;4:9. Doi: 10.1186/1742-6405-4-9 [published Online First: 2007/05/10][3] Vega LE, Espinoza LR. HIV infection and its effects on the development of autoimmune disorders. Pharmacol Res2018;129:1-9. Doi: 10.1016/j.phrs.2018.01.005 [published Online First: 2018/01/15][4] Sokoya T, Steel HC, Nieuwoudt M, et al. HIV as a Cause of Immune Activation and Immunosenescence. Mediators Inflamm2017;2017:6825493. Doi: 10.1155/2017/6825493 [published Online First: 2017/12/07][5] Yeo TH, Yeo TK, Wong EP, et al. Immune recovery uveitis in HIV pa...