scholarly journals Immune recovery vitritis

2007 ◽  
Vol 135 (9-10) ◽  
pp. 513-515 ◽  
Author(s):  
Mirjana Dujic ◽  
Djordje Jevtovic
Keyword(s):  
Opportunistic Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Immune Reconstitution ◽  
Vitreous Body ◽  
The Body ◽  
Immune Recovery ◽  
Cmv Retinitis ◽  
Highly Active ◽  
Dramatic Decline ◽  
Immune Recovery Vitritis

Introduction Immune recovery vitritis (IRV) is symptomatic vitritis of > 1+ severity associated with inactive cytomegalovirus (CMV) retinitis. It is an opportunistic infection of the eye, in the patients who suffer from AIDS, and is treated with a highly active antiretroviral therapy (HAART). As a result of this therapy, there is an immune reconstitution in the body and inflammation of the vitreous body. Objective The aim of the study was to show the incidence of IRV in patients treated with HAART. Method A retrospective study was conducted in patients who suffered from CMV retinitis. Twenty-one were treated with HAART and had the diagnosis of CMV retinitis, as well. All of them were examined by the same ophthalmologist who peformed slit lamp examination with mydriasis and indirect ophthalmoscopy. Results Nine of 21 patients developed IRV as a complication of HAART, two had cystoid macular edema (CMO). Conclusion CMV retinitis develops when the number of CD4+ T lymphocytes drops below 50/mm3. This results in necrotic retinitis which, if untreated, leads to complete loss of vision. With the introduction of HAART, we learned that the reconstitution of immune status was achieved as well as life expectancy, but there was a dramatic decline in the opportunistic infection, including CMV retinitis, as well. With the immune reconstitution, the inflammation develops in the eye, known as IRV. Sometimes, it is necessary to treat this condition, but in the case of our patients, the inflammation was mild, and no treatment was necessary.

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.

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

2007 ◽  
Vol 49 (4) ◽  
pp. 215-219 ◽  
Author(s):  
Luis Fernando Waib ◽  
Sandra Helena Alves Bonon ◽  
Angela Christina Salles ◽  
Gil Benard ◽  
Augusto César Penalva de Oliveira ◽  
...  
Keyword(s):  
Maintenance Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Immunological Response ◽  
Maintenance Phase ◽  
Induction Phase ◽  
Immune Recovery ◽  
Cd4 Cell Count ◽  
Cmv Retinitis ◽  
Highly Active ◽  
Almost All

BACKGROUND: Before the introduction of highly active antiretroviral therapy (HAART), CMV retinitis was a common complication in patients with advanced HIV disease and the therapy was well established; it consisted of an induction phase to control the infection with ganciclovir, followed by a lifelong maintenance phase to avoid or delay relapses. METHODS: To determine the safety of CMV maintenance therapy withdrawal in patients with immune recovery after HAART, 35 patients with treated CMV retinitis, on maintenance therapy, with CD4+ cell count greater than 100 cells/mm³ for at least three months, but almost all patients presented these values for more than six months and viral load < 30000 copies/mL, were prospectively evaluated for the recurrence of CMV disease. Maintenance therapy was withdrawal at inclusion, and patients were monitored for at least 48 weeks by clinical and ophthalmologic evaluations, and by determination of CMV viremia markers (antigenemia-pp65), CD4+/CD8+ counts and plasma HIV RNA levels. Lymphoproliferative assays were performed on 26/35 patients. RESULTS: From 35 patients included, only one had confirmed reactivation of CMV retinitis, at day 120 of follow-up. No patient returned positive antigenemia tests. No correlation between lymphoproliferative assays and CD4+ counts was observed. CONCLUSION: CMV retinitis maintenance therapy discontinuation is safe for those patients with quantitative immune recovery after HAART.

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

1999 ◽  
Vol 179 (3) ◽  
pp. 697-700 ◽  
Author(s):  
Marietta P. Karavellas ◽  
Daniel J. Plummer ◽  
J. Christopher Macdonald ◽  
Francesca J. Torriani ◽  
Chrisandra L. Shufelt ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Cytomegalovirus Retinitis ◽  
Immune Recovery ◽  
Highly Active ◽  
Immune Recovery Vitritis

scholarly journals Graves' Disease as a Manifestation of Immune Reconstitution in HIV-Infected Individuals after Initiation of Highly Active Antiretroviral Therapy

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Samad Rasul ◽  
Robert Delapenha ◽  
Faria Farhat ◽  
Jhansi Gajjala ◽  
Syeda Mehreen Zahra
Keyword(s):  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Immune Reconstitution ◽  
Immunological Response ◽  
Signs And Symptoms ◽  
Graves Disease ◽  
Typically Develop ◽  
Highly Active ◽  
Inflammatory Syndrome ◽  
Haart Therapy

Graves' disease after the initiation of highly active antiretroviral therapy (HAART) in certain HIV-1-infected individuals has been described as an immune reconstitution inflammatory syndrome (IRIS). This phenomenon should be suspected in individuals who present with clinical deterioration and a presentation suggestive of hyperthyroidism despite good virological and immunological response to HAART. Signs and symptoms of hyperthyroidism may be discrete or overt and typically develop 8–33 months after initiating therapy. One to two percent of HIV-infected patients can present with overt thyroid disease. Relatively few cases of Graves' IRIS have been reported in the literature to date. We describe four cases of Graves' IRIS in HIV-infected patients who were started on HAART therapy.

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