Robinson M R, Reed G, Csaky K G, Polis M A, Whitcup S M
National Institute of Health, Bethesda, Maryland 20892-1863, USA.
Am J Ophthalmol. 2000 Jul;130(1):49-56. doi: 10.1016/s0002-9394(00)00530-4.
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.
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 recovery in patients taking potent antiretroviral regimens. The ophthalmic characteristics of immune-recovery uveitis were identified, and their effect on visual acuity was statistically analyzed.
The mean CD4+ T-lymphocyte count for the 16 patients taking highly active antiretroviral therapy at the time of evaluation was 393 cells/microl (range, 97-1,338 cells/microl). Immune-recovery uveitis was characterized by vitreitis and optic disk and macular edema. Clinically important complications of immune-recovery uveitis included cataract and epiretinal membrane formation. The visual acuity scores were significantly worse in the 23 eyes with cytomegalovirus retinitis (mean, 67.2 letters, 20/50) than in the nine eyes without cytomegalovirus retinitis (mean, 89.8 letters, 20/16) (P <.001). Regression analysis showed that a lower visual acuity score was associated with the presence of moderate to severe macular edema on fluorescein angiography and vitreous haze (P < or =. 001).
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.
探讨接受高效抗逆转录病毒治疗的人类免疫缺陷病毒（HIV）感染且患有巨细胞病毒性视网膜炎患者免疫恢复相关的临床特征。
在马里兰州贝塞斯达的国立眼科研究所对16例患者进行前瞻性评估。评估内容包括病史和全面的眼科检查。检查包括使用对数视力表测量最佳矫正视力、裂隙灯生物显微镜检查、散瞳眼底检查、视网膜摄影和荧光素血管造影。免疫恢复性葡萄膜炎被定义为接受强效抗逆转录病毒治疗方案的患者中与临床免疫恢复相关的眼部炎症。确定免疫恢复性葡萄膜炎的眼科特征，并对其对视力的影响进行统计学分析。
在评估时，16例接受高效抗逆转录病毒治疗的患者的平均CD4 + T淋巴细胞计数为393个细胞/微升（范围为97 - 1338个细胞/微升）。免疫恢复性葡萄膜炎的特征为玻璃体炎以及视盘和黄斑水肿。免疫恢复性葡萄膜炎的重要临床并发症包括白内障和视网膜前膜形成。23只患有巨细胞病毒性视网膜炎的眼睛的视力评分（平均67.2字母，20/50）明显低于9只没有巨细胞病毒性视网膜炎的眼睛（平均89.8字母，20/16）（P <.001）。回归分析表明，较低的视力评分与荧光素血管造影显示的中度至重度黄斑水肿和玻璃体混浊有关（P ≤.001）。
在高效抗逆转录病毒治疗时代，免疫恢复性葡萄膜炎是HIV感染且患有巨细胞病毒性视网膜炎患者视力损害的重要原因。尽管与高效抗逆转录病毒治疗相关的免疫恢复使一些患者能够停止特定的抗巨细胞病毒治疗，但恢复的免疫反应可能与威胁视力的炎症有关。
