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Long-term posterior and anterior segment complications of immune recovery uveitis associated with cytomegalovirus retinitis

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2000年第1期130卷 57-64页

作者： Karavellas, MP Song, M MacDonald, JC Freeman, WR Univ Calif San Diego Dept Ophthalmol Shiley Eye Ctr La Jolla CA 92093 USA

PURPOSE: To identify and describe long-term posterior and anterior segment complications of immune recovery uveitis in patients with inactive cytomegalovirus retinitis who are undergoing highly active antiretroviral therapy-mediated recovery of immune function. METHODS: A prospective cohort study at a university medical center. Twenty-nine eyes of 21 patients with immune recovery uveitis and inactive cytomegalovirus retinitis were followed for 14.5 to 116 weeks (median, 43 weeks) after diagnosis of immune recovery uveitis, RESULTS: Nine eyes of nine patients developed visually important complications involving the posterior segment, anterior segment, or a combination of both. Posterior segment complications included severe proliferative vitreoretinopathy in three eyes and spontaneous vitreous hemorrhage from avulsion of a blood vessel secondary to tory syndrome that may result in complications months to years after the onset of inflammation. (C) 2000 by Elsevier Science Inc. All rights reserved.

关键词：眼前半段/病理学抗逆转录病毒治疗高效抗病毒药/治疗应用 CD4淋巴细胞计数 CD4阳性T淋巴细胞/生理学白内障/病因学白内障/病理学队列研究巨细胞病毒视网膜炎/并发症巨细胞病毒视网膜炎/药物疗法巨细胞病毒视网膜炎/免疫学巨细胞病毒视网膜炎/病毒学免疫系统/生理学虹膜炎/病因学虹膜炎/病理学虹膜炎/外科学前瞻性研究复发时间因素葡萄膜炎/并发症葡萄膜炎/药物疗法葡萄膜炎/免疫学葡萄膜炎/病毒学视敏度玻璃体视网膜病增生性/病因学玻璃体视网膜病增生性/病理学玻璃体视网膜病增生性/外科学玻璃体出血/病因学玻璃体出血/病理学玻璃体出血/外科学成年人人类男(雄)性

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Immune-recovery uveitis in patients with cytomegalovirus retinitis taking highly active antiretroviral therapy

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2000年第1期130卷 49-56页

作者： Robinson, MR Reed, G Csaky, KG Polis, MA Whitcup, SM NEI NIH Bethesda MD 20892 USA NIAID NIH Bethesda MD 20892 USA

PURPOSE: To investigate the clinical features associated with immune recovery in human immunodeficiency virus (HIV)-infected patients with cytomegalovirus retinitis who are taking highly active antiretroviral therapy. METHODS: Sixteen patients were evaluated prospectively at the National Eye Institute, Bethesda, Maryland. Evaluation included a medical history and a complete ophthalmologic examination. The examination included best corrected visual acuity score measured by means of logarithmic charts, slit-lamp biomicroscopy, dilated retinal examination, retinal photography, and fluorescein angiography. Immune-recovery uveitis was defined as the ocular inflammation associated with clinical immune the presence of moderate to severe macular edema on fluorescein angiography and vitreous haze (P less than or equal to .001). CONCLUSIONS: Immune-recovery uveitis is an important cause of visual morbidity in HIV-infected patients with cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Although immune recovery associated with highly active antiretroviral therapy has allowed some patients to discontinue specific anticytomegalovirus therapy, the rejuvenated immune response can be associated with sight-threatening inflammation. Published by Elsevier Science Inc.

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Longitudinal observations on mutations conferring ganciclovir resistance in patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis: The Cytomegalovirus and Viral Resistance Study Group Report Number 8

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2001年第5期132卷 700-710页

作者： Jabs, DA Martin, BK Forman, MS Dunn, JP Davis, JL Weinberg, DV Biron, KK Baldanti, F Hu, HL Johns Hopkins Univ Sch Med Dept Ophthalmol Baltimore MD 21205 USA Johns Hopkins Univ Sch Med Dept Med Baltimore MD 21205 USA Johns Hopkins Univ Bloomberg Sch Publ Hlth Dept Epidemiol Baltimore MD USA Johns Hopkins Med Inst Dept Pathol Baltimore MD 21205 USA Univ Miami Dept Ophthalmol Miami FL 33152 USA Northwestern Univ Sch Med Dept Ophthalmol Chicago IL 60611 USA Glaxo Wellcome Inc Res Triangle Pk NC 27709 USA IRCCS Policlin FB Serv Virol Pavia Italy

PURPOSE: Cytomegalovirus retinitis is the most com, mon intraocular infection in patients with acquired immunodeficiency syndrome (AIDS). With prolonged suppressive anticytomegalovirus maintenance therapy, resistance occurs in over 25% of patients. We evaluated longitudinal changes in the cytomegalovirus genotype in patients with cytomegalovirus retinitis who developed ganciclovir resistance that was demonstrated in either the blood or urine. METHODS: Patients with AIDS and previously untreated cytomegalovirus retinitis were followed prospectively for the occurrence of resistance while on treatment. Blood and urine specimens were obtained periodically for cytomegalovirus culture according to a predetermined schedule. Positive isolates were tested for phenotypic susceptibility and for mutations in the UL97 and UL54 genes. RESULTS: A mutation conferring resistance to ganciclovir in either the UL97 or UL54 gene was detected in 18 patients. In general, patients with a genotypically resistant virus developed increasing phenotypic resistance over time. There was a suggestion that unless therapy was changed, UL97 mutations tended to persist. In seven of eight patients, the mutations identified in isolates from the blood and urine were identical. In selected patients, there was a suggestion that a mixed population of cytomegalovirus might be present. Progression of the retinitis in an involved eye (15 of 18), contralateral eye retinitis (10 of 11), and extraocular cytomegalovirus disease (5 of 18) occurred commonly among patients with resistant virus. CONCLUSION: Resistance-conferring mutations in the cytomegalovirus genome emerge and may persist when the selective pressure for resistance is maintained. Some patients appear to harbor complex subpopulations of virus with different mutations and different levels of phenotypic resistance. Changes in therapy may result in a shift in virus population and changes in the cytomegalovirus genotype identified. (C) 2001 by Elsevier Sc

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Comparison of intraocular to plasma HIV-1 viral burden in patients with cytomegalovirus retinitis

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AMERICAN JOURNAL OF OPHTHALMOLOGY 1999年第2期127卷 221-223页

作者： Ciulla, TA Schnizlein-Bick, CT Danis, RP Frank, MO Wheat, LJ Indiana Univ Sch Med Dept Ophthalmol Indianapolis IN 46202 USA Indiana Univ Sch Med Dept Internal Med Div Infect Dis Indianapolis IN 46202 USA

PURPOSE: To determine the relationship between plasma and intraocular human immunodeficiency virus-1 (HIV-1) viral loads in 12 consecutive patients undergoing ganciclovir implant surgery for cytomegalovirus (CMV) retinitis. METHODS: Aqueous and vitreous specimens were assayed for HIV-1 viral load by polymerase chain reaction analysis (Roche Amplicor HIV Monitor;Roche Diagnostics Systems, Inc, Branchburg, New Jersey). RESULTS: It was possible to quantitatively assay HIV-1 burden in intraocular fluids using polymerase chain reaction analysis. In general, patients with plasma viral loads less than 250,000 copies/ml had undetectable (<200 copies/ml) HIV-1 in their aqueous and vitreous. CONCLUSIONS: It is likely that intraocular viral levels have several determinants in addition to plasma viral loads, with which they only partially correlate. (Am J Ophthalmol 1999;127:221-223. (C) 1999 by Elsevier Science Inc. All rights reserved.).

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Immune recovery uveitis

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2000年第1期130卷 103-106页

作者： Kuppermann, BD Holland, GN Univ Calif Los Angeles Jules Stein Eye Inst Ocular Inflammatory Dis Ctr Los Angeles CA 90095 USA Univ Calif Los Angeles Sch Med Dept Ophthalmol Los Angeles CA 90095 USA Univ Calif Irvine Sch Med Irvine CA 92717 USA

%In March 1998, the American Journal of Ophthalmology featured a cluster of publications[1, 2 and 3] that focused on the emerging problem of intraocular inflammation in patients with human immunodeficiency virus disease. Included was one of the early descriptions of "immune recovery uveitis," a condition in which heightened intraocular inflammatory reactions, attributable to the improved immune function associated with new potent antiretroviral therapies, occurs in some patients with preexisting cytomegalovirus retinitis. [3 and 4] Now, 2 years later, immune recovery uveitis is believed to be the leading cause of severe, new vision loss in patients with cytomegalovirus retinitis related to the acquired immunodeficiency syndrome. [5] Nevertheless, the disorder remains poorly understood. A recently published study^6 and two additional articles^7,8 in this issue of the journal address some of the questions that have arisen about immune recovery uveitis, and highlight many of the problems that remain to be solved.

关键词：抗逆转录病毒治疗高效抗病毒药/治疗应用 CD4淋巴细胞计数 CD4阳性T淋巴细胞/生理学巨细胞病毒视网膜炎/并发症巨细胞病毒视网膜炎/药物疗法巨细胞病毒视网膜炎/免疫学巨细胞病毒视网膜炎/病毒学眼疾病/病因学免疫系统/生理学葡萄膜炎/并发症葡萄膜炎/药物疗法葡萄膜炎/免疫学葡萄膜炎/病毒学人类

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