NECROTIZING HERPETIC RETINOPATHY IN PATIENTS WITH ADVANCED HIV DISEASE

Objectives: To describe the presenting features, clinical and laborato ry diagnosis, response to treatment, and outcome of necrotising herpet ic retinopathy (NHR) in HIV infected patients. Methods: Retrospective case records/laboratory data review of five HIV infected patients pres enting to the specialist HIV/AIDS unit at UCL Hospitals, London from A pril 1994 to August 1996 with a clinical diagnosis of NHR. Results: Al l patients had advanced HIV disease with a median CD4 count of 20 x 10 (6)/l. Three patients had cutaneous varicella tester virus (VZV) infec tion within the preceding 8 weeks. All had uniocular loss of visual ac uity; one also had headache and another ocular pain. All had typical r etinal appearances. VZV DNA was detected in cerebrospinal fluid of fou r patients (and in vitreous fluid of one of the four) and in vitreous fluid of one other. One patient refused therapy and rapidly became bli nd. Four patients received intravenous foscarnet with intravenous acic lovir for 6 weeks: three subsequently received oral famciclovir and on e oral valaciclovir; two patients also had intravitreal injections of foscarnet. In none of the four did treatment bring about improvement i n visual acuity, but in all four visual loss from retinitis was halted . Conclusions: NHR occurs in HIV infected patients with advanced HIV d isease and is strongly associated with evidence of VZV infection. With aggressive use of antiviral drugs the outcome is not uniformly poor.