Otiti-Sengeri Juliet, Meenken Christina, van den Horn Gerardus J, Kempen John H
Department of Ophthalmology, Makerere University and Mulago Hospital, Kampala, Uganda.
Curr Opin HIV AIDS. 2008 Jul;3(4):432-7. doi: 10.1097/COH.0b013e328302cc3d.
The aim of this article is to review the current literature concerning immune reconstitution inflammatory syndrome in relation to the eye. The definition, epidemiology, pathophysiology, risk factors, clinical features, diagnosis and treatment are discussed.
Immune reconstitution inflammatory syndrome affecting the eye has been documented in association with cytomegalovirus retinitis following the introduction of highly active antiretroviral therapy in a large number of patients. This syndrome is referred to as immune recovery uveitis, which is presumed to be mediated by recovery of immune responses specific to residual cytomegalovirus antigen located in the eye. In addition to improved immunity itself, risk factors include a low CD4 T count at the time of initiation of highly active antiretroviral therapy and involvement of a larger proportion of retina. Immune recovery uveitis is a major cause of visual loss and morbidity among patients with AIDS who are receiving highly active antiretroviral therapy.
Immune recovery uveitis is the most common form of immune reconstitution inflammatory syndrome in HIV-infected patients with cytomegalovirus retinitis who are receiving highly active antiretroviral therapy. Clear clinical definitions are required for ocular immune reconstitution inflammatory syndromes to avoid misclassification of other inflammatory conditions. A multidisciplinary approach is important in the diagnosis and management of immune recovery uveitis.
本文旨在综述当前有关眼部免疫重建炎症综合征的文献。讨论了其定义、流行病学、病理生理学、危险因素、临床特征、诊断及治疗。
在大量患者中引入高效抗逆转录病毒治疗后，已记录到眼部免疫重建炎症综合征与巨细胞病毒性视网膜炎相关。该综合征被称为免疫恢复性葡萄膜炎，推测是由针对眼部残留巨细胞病毒抗原的免疫反应恢复所介导。除了免疫本身改善外，危险因素还包括开始高效抗逆转录病毒治疗时CD4 T细胞计数低以及视网膜受累比例较大。免疫恢复性葡萄膜炎是接受高效抗逆转录病毒治疗的艾滋病患者视力丧失和发病的主要原因。
免疫恢复性葡萄膜炎是接受高效抗逆转录病毒治疗的合并巨细胞病毒性视网膜炎的HIV感染患者中最常见的免疫重建炎症综合征形式。眼部免疫重建炎症综合征需要明确的临床定义以避免其他炎症性疾病的错误分类。多学科方法在免疫恢复性葡萄膜炎的诊断和管理中很重要。
