Goldberg Daniel E, Smithen Lindsay M, Angelilli Allison, Freeman William R
Vitreous, Retina, Macula Consultants of New York, LuEsther T. Mertz Retinal Research Laboratory, Manhattan Eye, Ear and Throat Hospital, New York, New York 10022, USA.
Retina. 2005 Jul-Aug;25(5):633-49; quiz 682-3. doi: 10.1097/00006982-200507000-00015.
The effectiveness of highly active antiretroviral therapy (HAART) in restoring immune function in patients with acquired immunodeficiency syndrome (AIDS) has led to changes in the incidence, natural history, management, and sequelae of human immunodeficiency virus (HIV)-associated retinopathies, especially cytomegalovirus (CMV) retinitis.
The medical literature pertaining to HIV-associated retinopathies was reviewed with special attention to the differences in incidence, management strategies, and complications of these conditions in the eras both before and after the widespread use of HAART.
In the pre-HAART era, CMV retinitis was the most common HIV-associated retinopathy, occurring in 20%-40% of patients. Median time to progression was 47 to 104 days, mean survival after diagnosis was 6 to 10 months, and indefinite intravenous maintenance therapy was mandatory. Retinal detachment occurred in 24%-50% of patients annually. Herpetic retinopathy and toxoplasmosis retinochoroiditis occurred in 1%-3% of patients and Pneumocystis carinii choroiditis, syphilitic retinitis, tuberculous choroiditis, cryptococcal choroiditis, and intraocular lymphoma occurred infrequently. In the HAART era the incidence of CMV retinitis has declined 80% and survival after diagnosis has increased to over 1 year. Immune recovery in patients on HAART has allowed safe discontinuation of maintenance therapy in patients with regressed CMV retinitis and other HIV-associated retinopathies. Immune recovery uveitis (IRU) is a HAART dependent inflammatory response that may occur in up to 63% of patients with regressed CMV retinitis and elevated CD4 counts and is associated with vision loss from epiretinal membrane, cataract, and cystoid macular edema.
The incidence, visual morbidity, and mortality of CMV retinitis and other HIV-associated retinopathies have decreased in the era of HAART and lifelong maintenance therapy may safely be discontinued in patients with restored immune function. Patients with regressed CMV retinitis, however, may still lose vision from epiretinal membrane, cystoid macular edema, and cataract secondary to IRU.
高效抗逆转录病毒疗法（HAART）在恢复获得性免疫缺陷综合征（AIDS）患者免疫功能方面的有效性，已导致人类免疫缺陷病毒（HIV）相关视网膜病变，尤其是巨细胞病毒（CMV）视网膜炎的发病率、自然病程、治疗及后遗症发生了变化。
回顾了与HIV相关视网膜病变有关的医学文献，特别关注HAART广泛应用前后这些病症在发病率、治疗策略及并发症方面的差异。
在HAART时代之前，CMV视网膜炎是最常见的HIV相关视网膜病变，见于20% - 40%的患者。进展的中位时间为47至104天，诊断后的平均生存期为6至10个月，必须进行无限期静脉维持治疗。每年24% - 50%的患者发生视网膜脱离。疱疹性视网膜炎和弓形虫性视网膜脉络膜炎见于1% - 3%的患者，卡氏肺孢子虫脉络膜炎、梅毒性视网膜炎、结核性脉络膜炎、隐球菌性脉络膜炎和眼内淋巴瘤则较少见。在HAART时代，CMV视网膜炎的发病率下降了80%，诊断后的生存期延长至1年以上。接受HAART治疗的患者免疫功能恢复，使得CMV视网膜炎及其他HIV相关视网膜病变消退的患者能够安全地停用维持治疗。免疫恢复性葡萄膜炎（IRU）是一种依赖HAART的炎症反应，在CMV视网膜炎消退且CD4计数升高的患者中发生率可达63%，与视网膜前膜、白内障和黄斑囊样水肿导致的视力丧失有关。
在HAART时代，CMV视网膜炎及其他HIV相关视网膜病变的发病率、视觉损害及死亡率均有所下降，免疫功能恢复的患者可安全停用终身维持治疗。然而，CMV视网膜炎消退的患者仍可能因IRU继发的视网膜前膜、黄斑囊样水肿和白内障而丧失视力。
