Purpose:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
Keywords: AIDS/HIV • inflammation • clinical (human) or epidemiologic studies: outcomes/complications