Incidence of Immune Recovery Vitritis in Cytomegalovirus Retinitis Patients following Institution of Successful Highly Active Antiretroviral Therapy

Abstract

This study was conducted to determine the likelihood of the development of a new ocular inflammatory syndrome (immune recovery vitritis, IRV), which causes vision loss in AIDS patients with cytomegalovirus (CMV) retinitis, who respond to highly active antiretroviral therapy (HAART). We followed 30 HAART-responders with CD4 cell counts of >/=60 cells/mm3. Patients were diagnosed with IRV if they developed symptomatic vitritis of >/=1+ severity associated with inactive CMV retinitis. Symptomatic IRV developed in 19 (63%) of 30 patients and in 26 (59%) of 44 eyes over a median follow-up from HAART response of 13.5 months. The annual incidence of IRV was 83/100 person-years. Excluding patients with previous cidofovir therapy did not significantly alter the time course of IRV (P=.79). These data suggest that IRV develops in a significant number of HAART-responders with CMV retinitis and is unrelated to previous cidofovir therapy.

Withdrawal of maintenance therapy for cytomegalovirus retinitis in AIDS patients exhibiting immunological response to HAART

“…We encountered only one case of IRV, in contrast to the situation reported by KARAVELLAS et al 21 . In this patient there was an important increase in CD4+ count (126 cells/mm 3 before HAART to 336 cells/mm 3 during the onset of IRV) as described by JABS et al 16 .…”

“…In this patient there was an important increase in CD4+ count (126 cells/mm 3 before HAART to 336 cells/mm 3 during the onset of IRV) as described by JABS et al 16 . This case of IRV occurred later in the course of immune recovery than has been previously described 14,21 , suggesting that this event might occur even in patients showing long-term CD4+ response to HAART therapy.…”

Canadian Consensus Guidelines for the Management of Cytomegalovirus Disease in HIV/AIDS

“…IRU is an intraocular inflammation in response to CMV antigens, not a reactivation of CMV retinitis (20). The incidence of IRU varies from 0.11/year to 0.83/year (21,22) and occurs weeks to months following HAART initiation (22). Patients may note blurred vision, floaters, a loss of visual acuity (22) or, sometimes, ocular pain.…”

Prevención de las infecciones oportunistas en pacientes adultos y adolescentes infectados por el VIH. Recomendaciones de GESIDA/Plan Nacional sobre el Sida. Año 2003

“…Por todas estas razones, se puede concluir que el TARGA desempeña en la actualidad un papel de primer orden en la profilaxis y el tratamiento de la enfermedad por CMV independientemente del antiviral que estén recibiendo los pacientes. Un efecto adverso que conviene tener presente en los pacientes con retinitis por CMV que inician TARGA es la vitritis por re- cuperación inmune que en ocasiones produce una pérdida importante de la visión [13][14][15] .…”