A patient with AIDS often undergoes immune recovery following the initiation of highly active antiretroviral therapy (HAART). The eye may be affected, resulting in an immune recovery uveitis (IRU).


Cytomegalovirus (CMV) retinitis is usually present but may have been quiescent prior to the immune reconstitution.


Features of IRU:

(1) onset of clinical findings related to intraocular inflammation with

(1a) inflammation in the anterior chamber

(1b) inflammation in the vitreous humor (vitritis or vitreitis)

(1c) haziness of the vitreous humor

(1d) impaired vision

(1e) presence of "floaters"

(2) onset follows initiation of HAART

(3) evidence of immune recovery with an increase in the CD4 lymphocyte count



(1) epiretinal membrane formation

(2) cystoid macular edema

(3) edema of the optic disk

(4) cataract

(5) retinal detachment

(6) retinal neovascularization

(7) vision loss


Complications may not become evident for some time after starting HAART, so it is important to specifically look for this problem and to treat it aggressively, with many investigators using corticosteroids.


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