Intraocular Viral and Immune Pathogenesis of Immune Recovery Uveitis in Patients With Healed Cytomegalovirus Retinitis

Schrier, Rachel; Song, Mi-Kyoung; Smith, Irene L.; Karavellas, Marietta P.; Bartsch, Dirk-Uwe; Torriani, Francesca J.; Garcia, Claudio Renato; Freeman, William R.

doi:10.1097/00006982-200602000-00007

Cited by 62 publications

(47 citation statements)

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“…Over a longer time span, some patients also experience immune recovery uveitis (IRU), presenting as ocular inflammation (vitritis, macular edema, or formation of epiretinal membranes) and decreased vision. Most IRU patients also have a history of treated CMV retinitis before ART (126). Studies of patients who began ART in Western Australia before 1998 associated CMV retinitis and/or encephalomyelitis experienced during immune recovery on ART (CMV/encephalitis IRD) with a common major histocompatibility complex haplotype (HLA-A2, B44, TNFA-308*2, DR4) (114), suggesting similar immunopathological mechanisms.…”

Section: Ird Manifested As CMV Retinitis or Viral Encephalomyelitis: mentioning

confidence: 99%

“…Two studies demonstrated T-cell activity without active CMV replication in IRU. Schrier et al (126) compared fluids from eyes with IRU and those with CMV retinitis (collected pre-ART and CMV DNA positive). TNF, IL-4, and several chemokines were undetectable, but samples from eyes with IRU contained less IL-6 and more IL-12 than those from eyes with CMV retinitis.…”

Section: Ird Manifested As CMV Retinitis or Viral Encephalomyelitis: mentioning

confidence: 99%

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Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

et al. 2009

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SUMMARY Up to one in four patients infected with human immunodeficiency virus type 1 and given antiretroviral therapy (ART) experiences inflammatory or cellular proliferative disease associated with a preexisting opportunistic infection, which may be subclinical. These immune restoration diseases (IRD) appear to result from the restoration of immunocompetence. IRD associated with intracellular pathogens are characterized by cellular immune responses and/or granulomatous inflammation. Mycobacterial and cryptococcal IRD are attributed to a pathological overproduction of Th1 cytokines. Clinicopathological characteristics of IRD associated with viral infections suggest different pathogenic mechanisms. For example, IRD associated with varicella-zoster virus or JC polyomavirus infection correlate with a CD8 T-cell response in the central nervous system. Exacerbations or de novo presentations of hepatitis associated with hepatitis C virus (HCV) infection following ART may also reflect restoration of pathogen-specific immune responses as titers of HCV-reactive antibodies rise in parallel with liver enzymes and plasma markers of T-cell activation. Correlations between immunological parameters assessed in longitudinal sample sets and clinical presentations are required to illuminate the diverse immunological scenarios described collectively as IRD. Here we present salient clinical features and review progress toward understanding their pathogeneses.

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Section: Ird Manifested As CMV Retinitis or Viral Encephalomyelitis: mentioning

confidence: 99%

Section: Ird Manifested As CMV Retinitis or Viral Encephalomyelitis: mentioning

confidence: 99%

Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

et al. 2009

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“…Immune recovery uveitis was diagnosed as the presence of intraocular inflammation in a patient with healed CMV retinitis who had an immune response to HAART and was characterized by vitritis, macular edema, or epiretinal membrane formation in association with specific cytokine profiles (18) .…”

Section: Methodsmentioning

confidence: 99%

Clinical features and outcomes of AIDS-related cytomegalovirus retinitis in the era of highly active antiretroviral therapy

Arantes¹,

Garcia²,

Saraceno³

et al. 2010

Arq. Bras. Oftalmol.

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Clinical features and outcomes of AIDS-related cytomegalovirus retinitis in the era of highly active antiretroviral therapy Keywords: Cytomegalovirus; Retinitis; Acquired immunodeficiency syndrome; Antiretroviral therapy, highly active; AIDS-related opportunistic infections; Uveitis, posterior; Eye infections/etiology; HIV infections Purpose: To describe the features and outcomes of patients with AIDS-related cytomegalovirus retinitis after highly active antiretroviral therapy availability. Methods: Retrospective chart review of 30 consecutive patients (44 eyes) with AIDS and newly diagnosed, active AIDS-related cytomegalovirus retinitis, examined from January 2005 to December 2007. Results: The mean age was 34.8 years, 18 patients (60.0%) were male and median duration of AIDS was 90 months. Nineteen patients (63.3%) had evidence of highly active antiretroviral therapy failure and median CD4+ lymphocyte count was 12.5 cells/µl. Visual acuity at presentation was 20/40 or better in 27 eyes (61.4%). Retinitis involved Zone 1 in 13 eyes (39.5%). Despite specific anti-AIDSrelated cytomegalovirus therapy, 16 eyes (36.4%) presented relapse of retinitis and 10 eyes (22.7%) lost at least three lines of vision. When compared to highly active antiretroviral therapy responsive patients, eyes of highly active antiretroviral therapy failure patients were more likely to develop relapse of retinitis (p=0.03) and loss of at least three lines of vision (p=0.03). Conclusion: The patients in this series are essentially young men with longstanding AIDS, non-responsive to highly active antiretroviral therapy and with a similar immunological profile as noted before highly active antiretroviral therapy era. These findings have implications for the management of the disease and confirm the magnitude of rational periodic screening after diagnosis of AIDS. ABSTRACT INTRODUCTION

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“…IRU je povezan z zmernim poslabšanjem vidne ostrine, niso pa dokazali njegove povezave z aktivno replikacijo CMV ali z nadaljevanjem oz. prenehanjem anti--CMV-zdravljenja (42,43). Zdravljenje HAART lahko zažene CMV retinitis pri bolniku brez predhodne okužbe s CMV (angl.…”

Section: Oportunistične Okužbe Mrežnice In žIlnice 2421 Citomegalounclassified

Očesna stanja pri bolnikih z okužbo z virusom imunske pomanjkljivosti

Divjak

Grčar²,

Valentinčič

2017

SlovMedJour

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Ocular manifestations may be the frst sign of disseminated systemic HIV infection in HIV-infected individuals. Terefore, it is of the utmost importance to early diagnose ocular conditions that are not responsive to conventional ophthalmic treatment. HIV-related ocular manifestations can aﬀect the anterior (e.g. neoplasia and periocular tissue infections) as well as the posterior segment of the eye (e.g. retinopathy and opportunistic infections of the retina and choroid). Studies confrm that approximately 70 % of all HIV-infected patients suﬀer from at least one ocular manifestation caused by the HIV infection, so regular ophthalmic examinations are necessary in order to early diagnose and treat the disease, which might improve prognosis of the patient and prevent vision loss.In the frst part of the article we present some of the most common HIV-related ocular manifestations, while the second part of the article includes our experience in ophthalmic evaluation, followup and treatment recommendations.

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Intraocular Viral and Immune Pathogenesis of Immune Recovery Uveitis in Patients With Healed Cytomegalovirus Retinitis

Abstract: Inflammatory IRU can be differentiated from active CMV retinitis by the presence of IL-12, less IL-6, and absence of detectable CMV replication.

Cited by 62 publications

References 13 publications

Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

Clinical features and outcomes of AIDS-related cytomegalovirus retinitis in the era of highly active antiretroviral therapy

Očesna stanja pri bolnikih z okužbo z virusom imunske pomanjkljivosti

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