Abstract | BACKGROUND: METHODS: The medical literature pertaining to HIV-associated retinopathies was reviewed with special attention to the differences in incidence, management strategies, and complications of these conditions in the eras both before and after the widespread use of HAART. RESULTS: In the pre- HAART era, CMV retinitis was the most common HIV-associated retinopathy, occurring in 20%-40% of patients. Median time to progression was 47 to 104 days, mean survival after diagnosis was 6 to 10 months, and indefinite intravenous maintenance therapy was mandatory. Retinal detachment occurred in 24%-50% of patients annually. Herpetic retinopathy and toxoplasmosis retinochoroiditis occurred in 1%-3% of patients and Pneumocystis carinii choroiditis, syphilitic retinitis, tuberculous choroiditis, cryptococcal choroiditis, and intraocular lymphoma occurred infrequently. In the HAART era the incidence of CMV retinitis has declined 80% and survival after diagnosis has increased to over 1 year. Immune recovery in patients on HAART has allowed safe discontinuation of maintenance therapy in patients with regressed CMV retinitis and other HIV-associated retinopathies. Immune recovery uveitis (IRU) is a HAART dependent inflammatory response that may occur in up to 63% of patients with regressed CMV retinitis and elevated CD4 counts and is associated with vision loss from epiretinal membrane, cataract, and cystoid macular edema. CONCLUSIONS:
|
Authors | Daniel E Goldberg, Lindsay M Smithen, Allison Angelilli, William R Freeman |
Journal | Retina (Philadelphia, Pa.)
(Retina)
2005 Jul-Aug
Vol. 25
Issue 5
Pg. 633-49; quiz 682-3
ISSN: 0275-004X [Print] United States |
PMID | 16077362
(Publication Type: Journal Article, Review)
|
Chemical References |
|
Topics |
- AIDS-Related Opportunistic Infections
(drug therapy, epidemiology, immunology)
- Anti-HIV Agents
(therapeutic use)
- Antiretroviral Therapy, Highly Active
- Eye Infections, Viral
(drug therapy, epidemiology, immunology)
- Humans
- Immune System
(physiology)
- Incidence
- Retinal Diseases
(drug therapy, epidemiology, immunology)
- Survival Rate
- Uveitis
(immunology)
- Visual Acuity
|