Dionson Martin M
Department of Ophthalmology, Vicente Sotto Memorial Medical Center, Cebu City, Philippines.
Curr Opin Ophthalmol. 2024 Nov 1;35(6):507-512. doi: 10.1097/ICU.0000000000001078. Epub 2024 Jul 16.
This article intends to briefly discuss AIDS, summarize the current literature on immune recovery uveitis, describe its ocular manifestations and complications, and tackle its complex management.
The clinical picture of immune recovery uveitis is still evolving. Up to today, there are still no definite criteria for immune recovery uveitis, and although closely associated with cytomegalovirus retinitis and HIV/AIDS, there are several cases of similar intraocular response in non-HIV patients. The exact pathology for this paradoxical inflammatory reaction remains unclear; however, there is an interest in identifying biomarkers to determine underlying mechanisms and identify patients at risk. The management of this disease also remains a challenge and no standardized treatment approach exists currently.
Immune recovery uveitis is an important cause of visual morbidity particularly in HIV/AIDS patients receiving highly active antiretroviral. It is a paradoxical reaction that is frequently associated with a prior cytomegalovirus retinitis infection. Although it can be a transient and self-limiting process, there is a complex decision on the timing of antiviral treatment and the initiation of antiretroviral treatment to prevent immune recovery uveitis. Furthermore, a substantial challenge arises in balancingtreatment decisions for complications in refractory cases.
本文旨在简要讨论艾滋病，总结当前关于免疫重建葡萄膜炎的文献，描述其眼部表现和并发症，并探讨其复杂的治疗方法。
免疫重建葡萄膜炎的临床情况仍在演变。直至今日，免疫重建葡萄膜炎仍没有明确的诊断标准，尽管它与巨细胞病毒性视网膜炎和人类免疫缺陷病毒/艾滋病密切相关，但在非艾滋病患者中也有几例类似的眼内反应。这种矛盾的炎症反应的确切病理机制仍不清楚；然而，人们有兴趣识别生物标志物以确定潜在机制并识别高危患者。这种疾病的治疗仍然是一项挑战，目前尚无标准化的治疗方法。
免疫重建葡萄膜炎是导致视力损害的一个重要原因，尤其是在接受高效抗逆转录病毒治疗的艾滋病患者中。它是一种矛盾反应，常与先前的巨细胞病毒性视网膜炎感染有关。尽管它可能是一个短暂的自限性过程，但在抗病毒治疗时机和启动抗逆转录病毒治疗以预防免疫重建葡萄膜炎方面存在复杂的决策。此外，在平衡难治性病例并发症的治疗决策方面也面临重大挑战。
