Cytomegalovirus Retinitis After Initiation of Antiretroviral Therapy
Patients with human immunodeficiency virus (HIV) infection receiving antiretroviral therapy (ART), despite a reduced viral load and improved immune responses, may experience clinical deterioration. This so called "immune reconstitution inflammatory syndrome (IRIS)" is caused by inflammatory response to both intact subclinical pathogens and residual antigens. Cytomegalovirus retinitis is common in HIV-infected patients on ART with a cluster differentiation 4 (CD4+) counts less than 50 cells/mm3. We reported a patient with blurred vision while receiving ART. She had an unmasking classic CMV retinitis after ART.
Murdoch DM, Venter WDF, Van Rie A, Feldman C. Immune reconstitution inflammatory syndrome (IRIS), review of common infection manifestations and treatment options. AIDS Res Ther 2007; 4:9.
Jacobson MA, Zegans M, Pavan PR, O'Donnell JJ, Sattler F, Rao N, Owens S, Pollard R. Cytomegalovirus retinitis after initiation of highly active antiretroviral therapy. Lancet 1997; 349(9063):1443-5.
Haddow LJ, Easterbrook PJ, Mosam A, Khanyile NG,Parboosing R, Moodley P, Moosa MY. Defining immune reconstitution inflammatory syndrome: evaluation of expert opinion versus 2 case definitions in a South African cohort. Clin Infect Dis 2009; 49(1):1424-32.
Torre D, Speranza F, Martegani R. Impact of highly active antiretroviral therapy on organ-specific manifestations of HIV-1 infection. HIV Medicine 2005; 6(2):66-78.
Mandell GL, Bennett JE, Dolin R. Mandell, Douglas, and Bennett’s Principle and practice of infectious disease. 7th ed. Philadelphia: Churchill Livingstone. 2010.
Kempen JH, Min YI, Freeman WR, Holland GN, Friedberg DN, Dieterich DT, Jabs DA. Studies of Ocular Complications of AIDS Research Group. Risk of immune recovery uveitis in patients with AIDS and cytomegalovirus Retinitis. Ophthalmology 2006; 113(4):684-94.
Arevalo JF, Mendoza AJ, Ferretti Y. Immune Recovery uveitis in AIDS Patients with cytomegalovirus Retinitis treated with highly active antiretroviral therapy in Venezuela. Retina 2003; 23(4):495-502.
Shelburne SA, Hamill RJ. The immune Reconstitution inflammatory syndrome. AIDS Rev 2003; 5(2):67-79.
Gharai S, Venkatesh P, Garq S, Sharma SK, Vohra R. Ophthalmic manifestation of HIV infection in India in the Era of HAART: Analysis of loo consecutive patients evaluated at a tertiary Eye Care centre in India. Ophthalmic Epidemiol 2008; 15(4):264-71.
O’Connell N, Freeman N, Rabie H, Cotton MF. Presumed cytomegalovirus retinitis in human immunodeficiency virus type 1-infected South African children. Ped Infect Dis J 2011; 30(6):539-40.
Drew WL. Cytomegalovirus disease in the highly active antiretroviral therapy era. Curr Infect Dis Rep 2003; 5(3):257-65.
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