RAPIDLY PROGRESSIVE HERPETIC RETINAL NECROSIS - A BLINDING DISEASE CHARACTERISTIC OF ADVANCED AIDS

Eleven patients with rapidly progressive herpetic retinal necrosis (RP HRN) complicating AIDS were investigated retrospectively to study the disease spectrum, systemic involvement, and therapy, The mean CD4 cell count was 24/mu L. There was a characteristic disease pattern with ra pid progression, 82% bilaterality, relative resistance to intravenous antiviral therapy, and 70% retinal detachment. Varicella-zoster virus was the probable cause in 10 patients (detected by polymerase chain re action in two eyes investigated), and herpes simplex virus was the pro bable cause in one. Cutaneous tester occurred previously in 73% but wa s not concurrent. Seventy-three percent had central nervous system dis ease, possibly virus-related. RPHRN may be a local herpetic recrudesce nce in an immune-privileged site with transneural spread. Only four of 20 affected eyes retained useful vision, Poor ocular bioavailability, retina, ischemia, acquired drug resistance, and strain pathogenicity may underlie treatment failure. Acyclovir therapy appears relatively i neffective. Combined intravenous and intravitreal therapy with foscarn et and ganciclovir may be the best current management, Research advanc es are needed urgently.