Kim Jae Hyun, Cho Myung Ho, Ban Ji Hoon, Lee Sun Hee, Lee Jong Soo
Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea.
Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
Korean J Ophthalmol. 2025 Feb;39(1):71-79. doi: 10.3341/kjo.2024.0133. Epub 2025 Jan 20.
To investigate ocular manifestation of immune reconstitution inflammatory syndrome (IRIS) in HIV patients after starting highly active antiretroviral therapy (HAART) and its relationship to T cell immunity.
HIV patients with ocular IRIS after HAART were retrospectively reviewed. Clinical presentations with previous opportunistic infection, duration from initiation of HAART to IRIS, blood CD4+, CD8+ T cell count, and HIV RNA copies before HAART and at IRIS were analyzed.
Among 19 patients (27 eyes) included, the most common previous opportunistic infection was cytomegalovirus (17 patients, 89.5%) followed by tuberculosis choroiditis (2 patients, 10.5%). The clinical manifestations included vitritis (20 eyes, 74.0%), retinitis (14 eyes, 51.9%), and anterior uveitis (5 eyes, 18.5%). The median duration from initiation of HAART to IRIS was 70 days. CD4+ T cell count before HAART increased at IRIS (p < 0.001). CD8+ T cell count before HAART was negatively correlated with duration from HAART to IRIS (p < 0.001). The cutoff value of CD8+ T cell count for discerning early or late onset of ocular IRIS was 258/mm3 (p = 0.001). When divided into two groups by CD8+ T cell count of 258/mm3, 90% patients with CD8+ T cell count higher than 258/mm3 before HAART developed ocular IRIS within 70 days.
There was a negative relationship between CD8+ T cell count before HAART and duration from HAART to ocular IRIS. Ocular IRIS with higher CD8+ T cell count before HAART developed earlier after HAART initiation compared to those with lower CD8+ T cell count.
研究人类免疫缺陷病毒（HIV）患者开始高效抗逆转录病毒治疗（HAART）后免疫重建炎症综合征（IRIS）的眼部表现及其与T细胞免疫的关系。
对HAART治疗后发生眼部IRIS的HIV患者进行回顾性研究。分析患者既往机会性感染的临床表现、从开始HAART到发生IRIS的时间、血液中CD4⁺、CD8⁺ T细胞计数以及HAART治疗前和发生IRIS时的HIV RNA拷贝数。
纳入的19例患者（27只眼）中，最常见的既往机会性感染是巨细胞病毒感染（17例，89.5%），其次是结核性脉络膜炎（2例，10.5%）。临床表现包括葡萄膜炎（20只眼，74.0%）、视网膜炎（14只眼，51.9%）和前葡萄膜炎（5只眼，18.5%）。从开始HAART到发生IRIS的中位时间为70天。HAART治疗前的CD4⁺ T细胞计数在发生IRIS时增加（p < 0.001）。HAART治疗前的CD8⁺ T细胞计数与从HAART到发生IRIS的时间呈负相关（p < 0.001）。鉴别眼部IRIS早发或晚发的CD8⁺ T细胞计数临界值为258/mm³（p = 0.001）。以HAART治疗前CD8⁺ T细胞计数258/mm³分为两组，HAART治疗前CD8⁺ T细胞计数高于258/mm³的患者中，90%在HAART治疗70天内发生眼部IRIS。
HAART治疗前的CD8⁺ T细胞计数与从HAART到眼部IRIS的时间呈负相关。HAART治疗前CD8⁺ T细胞计数较高的眼部IRIS患者在HAART治疗开始后比CD8⁺ T细胞计数较低的患者发病更早。
