Human immunodeficiency virus and intraocular inflammation in the era of highly active anti retroviral therapy – An update

Abstract

Intraocular inflammation in patients with human immunodeficiency virus (HIV) infection is commonly due to infectious uveitis. Ocular lesions due to opportunistic infections (OI) are the most common and have been described extensively in the pre highly active antiretroviral therapy (HAART) era. Many eye lesions were classified as acquired immunodeficiency syndrome (AIDS) defining illnesses. HAART-associated improvement in immunity of the individual has changed the pattern of incidence of these hitherto reported known lesions leading to a marked reduction in the occurrence of ocular OI. Newer ocular lesions and newer ocular manifestations of known agents have been noted. Immune recovery uveitis (IRU), the new menace, which occurs as part of immune recovery inflammatory syndrome (IRIS) in the eye, can present with significant ocular inflammation and can pose a diagnostic and therapeutic challenge. Balancing the treatment of inflammation with the risk of reactivation of OI is a task by itself. Ocular involvement in the HAART era can be due to the adverse effects of some systemic drugs used in the management of HIV/AIDS. Drug-associated retinal toxicity and other ocular side effects are being increasingly reported. In this review, we discuss the ocular manifestations in HIV patients and its varied presentations following the introduction of HAART, drug-associated lesions, and the current treatment guidelines.

Ocular manifestations of people living with HIV in Tunisia

“…19 As reported in previous African data the most common ocular involvement in PLWH was retinopathy that is characterised by cotton-wool spots or associated with intra-retinal haemorrhages. 14,15,22 Patients having such manifestations are usually asymptomatic. 14,15 Posterior segment manifestations include, in addition to retinopathy, opportunistic infections of the retina and the choroid.…”

“…14,15,22 Patients having such manifestations are usually asymptomatic. 14,15 Posterior segment manifestations include, in addition to retinopathy, opportunistic infections of the retina and the choroid. The introduction of ART has led to a decrease in the incidence of these disorders.…”

“… 12 Although it has been considerably reduced by the introduction of ART, it may still be high, especially in areas with high HIV prevalence such as sub-Saharan Africa. 12 , 13 , 14 This may be because of an increase in the survival of these patients. 12 , 13 , 14 In the present study, the prevalence of ocular involvement was 36.7%, which is comparable to other African studies.…”

“… 12 , 13 , 14 This may be because of an increase in the survival of these patients. 12 , 13 , 14 In the present study, the prevalence of ocular involvement was 36.7%, which is comparable to other African studies. 13 , 15 However, ocular manifestations in this study might be under-reported because most of the PLWH do not receive routine ophthalmic screening.…”

Exploring a New Era in Uveitis

“…The issue begins with a beautiful account of the history and evolution of the USI, pays tribute to the pioneers of uveitis practice in India, and then moves on to many different forms of uveitis and scleritis. [ 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ]…”