Immune Recovery Uveitis and its Complications

Abstract

Intraocular inflammation in patients with human immunodeficiency virus infection is commonly due to infectious uveitis. Immune recovery uveitis, the new threat, which occurs as part of the immune recovery inflammatory syndrome in the eye, can present with significant ocular inflammation and can pose a diagnostic and therapeutic challenge. In the era before antiretroviral therapy, 50% to 75% of untreated human immunodeficiency virus-infected persons were reported to have ocular involvement, and the lower the CD4+ counts, the greater the risk. Patients who respond to antiretroviral therapy may develop immune recovery inflammatory syndromes as the recovering immune system begins to attack microbial antigens, to which the devastating immune system had previously been unable to respond. Immune recovery uveitis is a manifestation in which immunodeficient patients with previous cytomegalovirus retinitis experience an exaggerated increase in ocular inflammation after antiretroviral therapy. We present the case of a patient who is diagnosed with acquired immunodeficiency syndrome when he debuts with cytomegalovirus retinitis and subsequently, during the evolution of the disease, presents with immune recovery uveitis, which during its course develops ocular complications, eventually leading to irreversible visual loss of his right eye.