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Ocular immune reconstitution inflammatory syndromes

Otiti-Sengeri, Julieta; Meenken, Christinab; van den Horn, Gerardus Jc; Kempen, John Hd

Current Opinion in HIV and AIDS: July 2008 - Volume 3 - Issue 4 - p 432–437
doi: 10.1097/COH.0b013e328302cc3d
Immune restoration disease: Edited by Robert Colebunders and Martyn French

Purpose of review The aim of this article is to review the current literature concerning immune reconstitution inflammatory syndrome in relation to the eye. The definition, epidemiology, pathophysiology, risk factors, clinical features, diagnosis and treatment are discussed.

Recent findings Immune reconstitution inflammatory syndrome affecting the eye has been documented in association with cytomegalovirus retinitis following the introduction of highly active antiretroviral therapy in a large number of patients. This syndrome is referred to as immune recovery uveitis, which is presumed to be mediated by recovery of immune responses specific to residual cytomegalovirus antigen located in the eye. In addition to improved immunity itself, risk factors include a low CD4+ T count at the time of initiation of highly active antiretroviral therapy and involvement of a larger proportion of retina. Immune recovery uveitis is a major cause of visual loss and morbidity among patients with AIDS who are receiving highly active antiretroviral therapy.

Summary Immune recovery uveitis is the most common form of immune reconstitution inflammatory syndrome in HIV-infected patients with cytomegalovirus retinitis who are receiving highly active antiretroviral therapy. Clear clinical definitions are required for ocular immune reconstitution inflammatory syndromes to avoid misclassification of other inflammatory conditions. A multidisciplinary approach is important in the diagnosis and management of immune recovery uveitis.

aDepartment of Ophthalmology, Makerere University and Mulago Hospital, Kampala, Uganda

bDepartment of Ophthalmology, VU Medical Centre, The Netherlands

cDepartment of Ophthalmology, Medical Center Jan van Goyen, Amsterdam, The Netherlands

dDepartments of Ophthalmology and Epidemiology, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

Correspondence to Dr Juliet Otiti-Sengeri, MBCh, B, M.Med Ophthalmology, Department of Ophthalmology, Makerere University and Mulago Hospital, P. O. Box 7072, Kampala, Uganda Tel: +256 77 381162; fax: +256 41 255962; e-mail: ojsjuliet@hotmail.com

© 2008 Lippincott Williams & Wilkins, Inc.