Uveitis in Human Immunodeficiency Virus–infected Individuals

Abstract

Both infectious and non-infectious forms of uveitis may occur in persons who test positively for the human immunodeficiency virus (HIV). As the use of highly active antiretroviral therapy (HAART) has become standard of care in many countries, the spectrum of uveitis has changed in this group of people. Opportunistic infectious diseases, including cytomegalovirus (CMV) retinitis, continue to occur in HIV-positive patients who suffer from AIDS. Amongst immune competent persons, syphilis is a common cause of infectious uveitis. Several uveitic syndromes that respond to HAART have been specifically associated with HIV. Immune recovery uveitis is a common noninfectious uveitis in HAART-treated HIV-positive persons with a history of CMV retinitis.Other non-infectious forms of uveitis that occur in HIV-negative individuals may also affect HIV-positive persons, although the latter group may have a higher risk of entities such as HLA B27-associated uveitis, drug-induced uveitis and vitreoretinal lymphoma.This review presents an overview of the causes of uveitis in HIV-positive people. A comprehensive ocular and systemic history and examination, with directed testing, is recommended for all HIV-positive persons presenting with uveitis, due to the broad spectrum of diseases that may be associated with uveitis in these individuals.

Uveitis is predominantly of infectious origin in a high HIV and TB prevalence setting in rural South Africa

“…The HIV epidemic impacts greatly on the burden of uveitis in this region. HIV-infected individuals have an increased risk of uveitis, in particular of infectious aetiology, and experience more severe disease 1 3 4. Furthermore, the influence of the high tuberculosis (TB) prevalence in this region on uveitis aetiology is unknown.…”

Intraocular Lymphoma

“…For this reason, the differential diagnosis in severely immunosuppressed patients suspected of having VRL should include infections known to occur in those with acquired immune deficiency syndrome (AIDS) -most notably cytomegalovirus (CMV), syphilis, and toxoplasmosis. 26,27 Many HIV-infected patients with PCNSL, and again by extension VRL, have active Epstein-Bar virus (EBV) infectionpresumably related to relative loss of EBV suppressing CD4 + T-cells. In addition to the diagnostic studies mentioned above by Carbonell et al, 12 Steffen et al 13 noted that testing of tissue or fluid samples for the presence of EBV DNA may have value.…”