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Jennifer Rose-Nussbaumer, Debra A. Goldstein, Nisha R. Acharya, Jennifer E. Thorne, Akbar Shakoor, Steven Yeh, Hassan Rahman, Christina J. Flaxel, Justine R. Smith; Uveitis in Immunocompetent Persons Infected with Human Immunodeficiency Virus (HIV). Invest. Ophthalmol. Vis. Sci. 2011;52(14):4274.
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Uveitis in an individual who is HIV+ may pose a diagnostic dilemma. Prior to introduction of highly active anti-retroviral therapy, a majority of patients presented with severely reduced CD4 T cell levels and CMV retinitis. Today infected individuals experience relative immune competence, and this diagnosis is less common. We investigated types, causes and outcomes of uveitis in HIV+ patients with CD4 T cell count ≥ 200 cells/µl at diagnosis.
We collected clinical data from the uveitis clinics of Emory University, Johns Hopkins University, Oregon Health & Science University, University of California at San Francisco and University of Illinois at Chicago for HIV+ patients with CD4 T cell count ≥ 200 cells/µl. These data included demographic information, disease characteristics, medical interventions and visual outcomes.
Clinical information was recorded for 11 females and 23 males (mean age: 44 years, range 26 - 68 years) in whom CD4 T cell count ranged from 213 - 1137 cells/µl at diagnosis of the uveitis. 13 patients had AIDS. Average follow-up of the uveitis was 23 months. Uveitis was bilateral in 18 and unilateral in 16. In 33 cases uveitis could be classified: uveitis was anterior (55%), intermediate (9%), anterior/intermediate (15%), posterior (9%) and pan (12%); with a sudden (55%) or insidious (45%) onset; of limited (50%) or persistent (50%) duration; and with acute (28%), recurrent (34%) or chronic (38%) course. Etiologies were: infectious (35%), including syphilis and herpes virus infection; autoimmune (18%); immune recovery (9%); medication-induced (3%); and idiopathic (35%). Complications observed in at least 15% of patients were posterior synechiae, cataract, papillitis and cystoid macula edema. Visual acuity at presentation was > 20/50 in 72% and ≤ 20/200 in 6% of 53 eyes; final visual acuity was > 20/50 in 81% and ≤ 20/200 in 4% of 47 eyes.Treatments were diverse, varying with etiology and type of uveitis, and included topical, locally injected and oral corticosteroid, and topical, intravitreally injected and oral antimicrobials.
In patients with HIV infection and relative immune competence, uveitis may take multiple forms and present diverse etiologies. Although complications are frequent, good visual acuity is usually maintained.
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