scholarly journals Immune Recovery Uveitis: Pathogenesis, Clinical Symptoms, and Treatment

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Beata Urban ◽  
Alina Bakunowicz-Łazarczyk ◽  
Marta Michalczuk
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Visual Loss ◽  
Clinical Symptoms ◽  
Clinical Findings ◽  
Immune Recovery ◽  
Cd4 Counts ◽  
Immune Recovery Uveitis ◽  
Ocular Manifestations ◽  
Highly Active ◽  
Inflammatory Syndrome

IRU is the most common form of immune reconstitution inflammatory syndrome in HIV-infected patients with cytomegalovirus retinitis who are receiving highly active antiretroviral therapy (HAART). Among patients with CMV in the HAART era, immune recovery may be associated with a greater number of inflammatory complications, including macular edema and epiretinal membrane formation. Given the range of ocular manifestations of HIV, routine ocular examinations and screening for visual loss are recommended in patients with CD4 counts <50 cells/μL. With the increasing longevity of these patients due to the use of HAART, treatment of IRU may become an issue in the future. The aim of this paper is to review the current literature concerning immune recovery uveitis. The definition, epidemiology, pathophysiology, clinical findings, complications, diagnosis, and treatment are presented.

Uveitis associated with Immunodeficiency and Drugs; Clinical Findings, Diagnosis, and Treatment

2020 ◽  
pp. 277-283
Keyword(s):  
Anterior Uveitis ◽  
Highly Active Antiretroviral Therapy ◽  
Rare Event ◽  
Clinical Findings ◽  
Diagnosis And Treatment ◽  
Immune Recovery ◽  
Drug Induced ◽  
Cmv Retinitis ◽  
Ocular Manifestations ◽  
Highly Active

Immüne recovery uveitis (IRU) is the most common form of immune reconstitution inflammatory syndrome in human immunodeficiency virus (HIV) infected patients with cytomegalovirus (CMV) retinitis who are receiving highly active antiretroviral therapy (HAART) therapy. In patients with CMV retinitis in the HAART era, immune recovery may be associated with a greater number of inflammatory complications, including vitritis, macular edema, epiretinal membrane formation, papillitis, and iris synechiae. Given the range of ocular manifestations of HIV, routine ocular examinations and screening carefully for visual loss are recommended in patients with CD4 counts <50 cells/μL. With the increasing longevity of these patients due to the use of HAART, treatment of IRU may become an issue in the future. Uveitis has been associated with a number of systemic, intravitreal, and topical medications, and may also occur after vaccination and the use of other substances. However, drug-induced uveitis is a relatively rare event. Only a few drugs have been proven to cause uveitis, whereas many others may not represent a direct cause-and-effect relationship. Anterior uveitis is the most common clinical presentation and therefore, patients with new-onset anterior uveitis should be asked whether they have recently started any new medications. These patients need to undergo the same diagnostic protocol followed for any uveitis case. Drug-induced uveitis is almost always reversible within weeks of cessation of the medication and the institution of topical treatment of the inflammation. The clinical findings, diagnosis, and treatment of IRU and drug-induced uveitis are presented in this current study

scholarly journals Immune Recovery Uveitis Masked as an Endogenous Endophthalmitis in a Patient with Active CMV Retinitis

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Ligia Figueiredo ◽  
Renata Rothwell ◽  
Miguel Bilhoto ◽  
Rosário Varandas ◽  
Sofia Fonseca
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Endogenous Endophthalmitis ◽  
Immune Recovery ◽  
Blurred Vision ◽  
Positive Polymerase Chain Reaction ◽  
Immune Recovery Uveitis ◽  
Cmv Retinitis ◽  
Highly Active ◽  
Polymerase Chain ◽  
The Right

Cytomegalovirus (CMV) retinitis may occur in profoundly immunocompromised patients and be the initial AIDS-defining infection. The incidence and prevalence of CMV retinitis has declined substantially in the era of highly active antiretroviral therapy (HAART); nevertheless, it remains a leading cause of ocular morbility. We report the case of a 40-year-old man with blurred vision and pain in the right eye, three weeks after the initiation of effective HAART treatment. Ocular examination revealed a panuveitis causing an anterior chamber reaction with hypopyon and a dense vitreous haze. An endogenous endophthalmitis was suspected and treatment was ensued, without improvement. A vitreous tap was performed, and a positive polymerase chain reaction for CMV was found. A diagnosis of immune recovery uveitis (IRU) was made, and the patient responded to treatment with valganciclovir and dexamethasone. IRU is an intraocular inflammation that develops in patients with HAART-induced immune recovery and inactive CMV retinitis, although cases of active CMV retinitis have been described. Presentation with panuveitis and hypopion is rare and may be misleading regarding diagnosis and management.

scholarly journals Progressive Multifocal Leukoencephalopathy in HIV-Infected Children: A Case Report and Literature Review

2009 ◽  
Vol 2009 ◽  
pp. 1-6 ◽  
Author(s):  
Peninnah Oberdorfer ◽  
Charles H. Washington ◽  
Kamornwan Katanyuwong ◽  
Podjanee Jittamala
Keyword(s):  
White Matter ◽  
Highly Active Antiretroviral Therapy ◽  
Clinical Symptoms ◽  
Rna Virus ◽  
White Matter Lesions ◽  
Subcortical White Matter ◽  
Hiv Rna ◽  
Highly Active ◽  
The Right ◽  
Inflammatory Syndrome

We report a case of a perinatally HIV-infected patient aged 9 years, who presented with right-sided hemiplegia. His initial CD4 T-cell was of 0.21% (4 cells/μL) and plasma HIV RNA virus of 185 976 copies/mL (log 5.27). Plasma and CSF samples were subsequently positive for JCV. Twelve days after the initiation of highly active antiretroviral therapy (HAART), the MRI showed progressive white matter lesions with asymmetrical deep and subcortical white matter lesions over the left frontotemporoparietal region and the right frontal lobe. Immune Reconstitution Inflammatory Syndrome (IRIS) was suspected, and the patient was treated with methylprednisolone. His clinical symptoms worsened and despite therapy the patient deteriorated.

Immune Reconstitution Inflammatory Syndrome Associated With Kaposi's Sarcoma

2005 ◽  
Vol 23 (22) ◽  
pp. 5224-5228 ◽  
Author(s):  
M. Bower ◽  
M. Nelson ◽  
A.M. Young ◽  
C. Thirlwell ◽  
T. Newsom-Davis ◽  
...  
Keyword(s):  
Immune Reconstitution Inflammatory Syndrome ◽  
Highly Active Antiretroviral Therapy ◽  
Immune Reconstitution ◽  
Kaposi's Sarcoma ◽  
Clinical Status ◽  
Kaposi’S Sarcoma ◽  
Cd4 Counts ◽  
Highly Active ◽  
Time To Treatment Failure ◽  
Inflammatory Syndrome

Purpose A proportion of patients with HIV infection who subsequently receive highly active antiretroviral therapy (HAART) exhibit a deterioration in their clinical status, despite control of virologic and immunologic parameters. This clinical response, known as the immune reconstitution inflammatory syndrome (IRIS), occurs secondary to an immune response against previously diagnosed pathogens. Patients and Methods From our cohort of 5,832 patients treated in the HAART era, we identified 150 therapy-naive patients with a first presentation of Kaposi's sarcoma (KS). Their clinicopathologic features and progress were recorded prospectively. Results After commencing HAART, ten patients (6.6%) developed progressive KS, which we identify as IRIS-associated KS. In a comparison of these individuals with those whose KS did not progress, we found that IRIS-KS occurred in patients with higher CD4 counts (P = .03), KS-associated edema (P = .01), and therapy with both protease inhibitors and non-nucleosides together (P = .03). Time to treatment failure was similar for both groups, although the CD4 count declined more rapidly at first, in those patients with IRIS-associated KS. Despite this initial decline, in our clinical experience HAART could be successfully continued in those with IRIS-associated KS. Conclusion We have identified IRIS-KS in a cohort of HIV patients with KS who start HAART.

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