Posterior segment involvement in HIV-associated eye disease after the commencement of highly active antiretroviral therapy (HAART)

The panel of therapeutic options available for the treatment of retroviral disorders has expanded explosively in recent years, with the result that it has now became possible to reconstitute the immune function of individuals with advanced HIV-disease to a remarkable degree. The ophthalmologist is t hus confrontated with completely new clinical situations, courses of treatm ent and decisions. For example, a CMV-retinitis developing within six weeks of the onset of HAART does not necessarily require specific treatment, and reactivation of a retinitis within the same time span is often barely dist inguishable from an inflammatory reaction induced by the reconstituted lymp hocytes. Marked cellular infiltration of the vitreous - in the absence of a n active retinal or chorioretinal lesion - is the hallmark of this immune-r ecovery vitreitis and responds nicely to systemic steroid treatment. In the course of retinitis, macular edema and epiretinal membrane formation are n ot uncommonly responsible for visual impairment. If, on the other hand, imm unological parameters remain stable during the course of three months, i.e. , if the CD4 cell count is more than 150-250 mu l and the plasma load of HI V-T is less than 5-10,000 copies/mu l, then what has until now been deemed to be a lifelong therapy for CMV-retinitis may be interrupted, provided the clinical (i.e., retinal) situation can be controlled on a regular basis. In this article, an attempt is made to discuss and interpret clinical findi ngs pertaining to posterior segment involvement in ocular HIV disease, with a view to guiding the clinical practitioner in his/her course of action.