Uveitis in patients treated with intravenous cidofovir

Purpose: To study the characteristics of uveitis occuring during intravenou s cidofovir treatment for CMV retinitis in patients with AIDS. Patients and methods: We retrospectively studied ten cases (16 eyes) of uveitis in pati ents with CMV retinitis treated with intravenous cidofovir. All the patient s had ophthalmologic examinations and, if required, fundus angiographies. T he median follow-up was eight months. Results: Uveitis occurred after a mea n of 8.5 infusions of cidofovir (range 2-17). All ten patients were on prot ease inhibitors. The mean CD4+ cell count was 92 +/- 51/mu l and the median viral load was 3.9 log. All the eyes with uveitis had healed CMV retinitis . The first examination of the involved eyes showed inflammation of the ant erior chamber (I00%), vitritis (50%), posterior synechiae (75%), and low in traocular pressure (94%) Uveitis did not relapse in the seven patients who stopped cidofovir, whereas it relapsed in two of the three patients who did not stop treatment. At the end of follow-up, permanent posterior synechiae were present in 69% of the involved eyes. Comments: Cidofovir therapy nece ssitates slit-lamp surveillance, especially in patients on HAART. Cidofovir -related uveitis requires a local steroid treatment, but if possible, cidof ovir should be withdrawn.