HIV Retinopathy and Immune Reconstitution Uveitis on CMV Retinitis: A Case Report

Aim: In HIV patients with CD4+count<50cells/µL, after initiating HAART, close ophthalmological monitoring is mandatory, in order to watch for the development of IRU.

Case Presentation: A 39-year-old patient with unknown medical history consulted for blurred vision and myodesopsia. The examination found bilateral microangiopathy with temporal retinal ischemia in the right eye.

The patient was tested positive for HIV-1 with a CD4count of 43 cells/mm3. The diagnosis of HIV-microangiopathy was made, he received a prophylactic retinal argon-laser and was put on HAART.

Following the HAART, he presented decreased VA in the right eye, with in examination, a slight inflammation of the AC, moderate hyalitis, and a diffuse and confluent temporal retinal necrosis.

The diagnosis of IRU associated with CMV-retinitis was presumed.

Discussion: The HAART increases the number of CD4-T-cells and restores immune responses against a wide variety of pathogens which reduces the incidence of opportunistic infections. However, in some patients, a dysregulated immune response after initiation of HAART leads to the immune reconstitution inflammatory disease, characterized by the paradoxical aggravation of a treated opportunistic infection or the revealing of a previously untreated subclinical infection in HIV-positive patients. The ocular manifestation of IRIS is called immune reconstitution uveitis (IRU).

IRU usually develops in patients with inactive CMV retinitis, but it can rarely occur in eyes with active CMV retinitis and occurs within the first few weeks of starting HAART.

Conclusion: The initiation of HAART requires regular general and ophthalmological monitoring in order to recognize early IRU which is often associated with active CMV retinitis.