Immune Recovery Vitritis Associated With Inactive Cytomegalovirus Retinitis

Karavellas, Marietta P.; Lowder, Careen Y.; Macdonald, Jonathan; Avila, Cesar P.; Freeman, William R.

doi:10.1001/archopht.116.2.169

Cited by 189 publications

(116 citation statements)

References 17 publications

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“…ϩ T-cell responses have been reported in studies using a variety of different patients, epitopes, and methods (3,5,6,13,15,18,19). We report here the CD8 ϩ T-cell responses of eight treatment naive patients to 95 optimized cytotoxic T-lymphocyte (CTL) peptide epitopes and to a putative immunodominant HLA A2 cytomegalovirus (CMV) peptide epitope after the initiation of HAART, using a functional assay for T-cell response to antigen.…”

Section: A Wide Range Of Values For the Rates Of Decay Of Cd8mentioning

confidence: 99%

Decay Kinetics of Human Immunodeficiency Virus-Specific CD8⁺T Cells in Peripheral Blood after Initiation of Highly Active Antiretroviral Therapy

Casazza

Betts

Picker

et al. 2001

J Virol

156

124

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We measured the longitudinal responses to 95 HLA class I-restricted human immunodeficiency virus (HIV) epitopes and an immunodominant HLA A2-restricted cytomegalovirus (CMV) epitope in eight treatment-naive HIV-infected individuals, using intracellular cytokine staining. Patients were treated with highly active antiretroviral therapy (HAART) for a median of 78 weeks (range, 34 to 121 weeks). Seven of eight patients maintained an undetectable viral load for the duration of therapy. A rapid decline in HIV-specific CD8 ؉ T-cell response was observed at initiation of therapy. After an undetectable viral load was achieved, a slower decrease in HIV-specific CD8 ؉ T-cell response was observed that was well described by first-order kinetics. The median half-life for the rate of decay was 38.8 (20.3 to 68.0) weeks when data were expressed as percentage of peripheral CD8 ؉ T cells. In most cases, data were similar when expressed as the number of responding CD8 ؉ T cells per microliter of blood. In subjects who responded to more than one HIV epitope, rates of decline in response to the different epitopes were similar and varied by a factor of 2.2 or less. Discontinuation of treatment resulted in a rapid increase in HIV-specific CD8 ؉ T cells. Responses to CMV increased 1.6-and 2.8-fold within 16 weeks of initiation of HAART in two of three patients with a measurable CMV response. These data suggest that HAART quickly starts to restore CD8 ؉ T-cell responses to other chronic viral infections and leads to a slow decrease in HIV-specific CD8 ؉ T-cell response in HIV-infected patients. The slow decrease in the rate of CD8 ؉ T-cell response and rapid increase in response to recurrent viral replication suggest that the decrease in CD8 ؉

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Section: A Wide Range Of Values For the Rates Of Decay Of Cd8mentioning

confidence: 99%

Decay Kinetics of Human Immunodeficiency Virus-Specific CD8⁺T Cells in Peripheral Blood after Initiation of Highly Active Antiretroviral Therapy

Casazza

Betts

Picker

et al. 2001

J Virol

156

124

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“…In a previous study we reported three cases of CME: one improved without treatment, one improved with oral corticosteroids, and the last one improved after posterior sub-Tenon injections of Depo-Medrol. 4 However, in this study we have a larger number of eyes and longer follow-up period.…”

Section: Discussionmentioning

confidence: 84%

“…The syndrome is associated with increased immunocompetence as a result of highly active antiretroviral treatment (HAART) including protease inhibitors. 4,5 The clinical picture of IRU is still evolving. We previously reported that IRU is a persistent condition and is characterized clinically by a decrease of vision, floaters, vitritis, papillitis, and macular changes including macular edema and epiretinal membrane (ERM).…”

mentioning

confidence: 99%

Long-Term Results of Treatment of Macular Complications in Eyes With Immune Recovery Uveitis Using a Graded Treatment Approach

El-Bradey

Cheng²,

Song³

et al. 2004

Retina

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Purpose: To evaluate the results of a graded treatment approach in a cohort of eyes with macular complications of immune recovery uveitis. Methods:A cohort of 18 eyes of 13 patients representing all eyes with these complications at the University of California, San Diego AIDS Ocular Treatment Unit was studied. Eyes were classified into three groups and treated according to a graded protocol. Results:Eyes with mild disease (macular edema and vision of 20/30 or better) were observed. These six eyes maintained good vision with only one dropping to 20/40. In eyes with worse macular edema and vision of 20/30 or worse (10 eyes of 9 patients), repository sub-Tenon steroid injections were used repeatedly. There were no complications of steroid use but visual improvement occurred in only 40% of eyes. Macular edema persisted. In eyes with structural macular changes, such as epiretinal membrane, vitrectomy resulted in vision improvement in three of four eyes. The cystoid macular edema persisted despite surgery. Conclusion:Mild cases of immune recovery uveitis and macular edema may be observed. In eyes with reduction of vision due to cystoid macular edema, there was only a modest treatment effect using repository corticosteroids. Eyes with immune recovery uveitis that develop epiretinal membrane undergo some visual improvement after removal of the membrane. The macular edema of immune recovery uveitis is resistant to corticosteroid treatment.Keywords cytomegalovirus retinitis; epiretinal membrane; human immunodeficiency virus; macular edema; uveitis Cytomegalovirus retinitis (CMV) is the most common cause of blindness in patients with acquired immunodeficiency syndrome (AIDS). 1 Typically, CMV is a late opportunistic infection and generally occurs after the CD4 T lymphocyte count has fallen below 50 cells/ mm 3 and very rarely at CD4 counts above 100/mm 3 . 2 CMV in patients with AIDS is typically Correspondence to: WILLIAM R. FREEMAN.

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“…6,7 Recently, immune recovery uveitis has been recognised in AIDS patients who have received highly active anti-retroviral therapy. 27 This syndrome includes transient ocular inflammation, including vitritis and anterior uveitis. Immune recovery uveitis is thought to result from restoration of immune function and consequent immunological recognition of opportunistic infections of the ocular tissues.…”

Section: Discussionmentioning

confidence: 99%

Congenital nuclear cataracts and uveitis in HIV-transgenic mice

Mózes¹,

Bryant²,

Franks³

et al. 2002

Eye

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Immune Recovery Vitritis Associated With Inactive Cytomegalovirus Retinitis

Cited by 189 publications

References 17 publications

Decay Kinetics of Human Immunodeficiency Virus-Specific CD8⁺T Cells in Peripheral Blood after Initiation of Highly Active Antiretroviral Therapy

Decay Kinetics of Human Immunodeficiency Virus-Specific CD8⁺T Cells in Peripheral Blood after Initiation of Highly Active Antiretroviral Therapy

Long-Term Results of Treatment of Macular Complications in Eyes With Immune Recovery Uveitis Using a Graded Treatment Approach

Congenital nuclear cataracts and uveitis in HIV-transgenic mice

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Immune Recovery Vitritis Associated With Inactive Cytomegalovirus Retinitis

Cited by 189 publications

References 17 publications

Decay Kinetics of Human Immunodeficiency Virus-Specific CD8+T Cells in Peripheral Blood after Initiation of Highly Active Antiretroviral Therapy

Decay Kinetics of Human Immunodeficiency Virus-Specific CD8+T Cells in Peripheral Blood after Initiation of Highly Active Antiretroviral Therapy

Long-Term Results of Treatment of Macular Complications in Eyes With Immune Recovery Uveitis Using a Graded Treatment Approach

Congenital nuclear cataracts and uveitis in HIV-transgenic mice

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Decay Kinetics of Human Immunodeficiency Virus-Specific CD8⁺T Cells in Peripheral Blood after Initiation of Highly Active Antiretroviral Therapy

Decay Kinetics of Human Immunodeficiency Virus-Specific CD8⁺T Cells in Peripheral Blood after Initiation of Highly Active Antiretroviral Therapy