Human immunodeficiency virus and intraocular inflammation in the era of highly active anti retroviral therapy - An update

• Published in: Indian journal of ophthalmology 2020-09, Vol.68 (9), p.1787-1798
• Main Authors: Sudharshan, Sridharan, Nair, Nivedita, Curi, Andre, Banker, Alay, Kempen, John
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; AIDS-Related Opportunistic Infections - drug therapy; Antiretroviral Therapy, Highly Active - adverse effects; Care and treatment; cmv retinitis; Crystalline lens; Cytomegalovirus Retinitis; Diagnosis; Drug therapy; drug-induced uveitis; haart; herpes zoster; Highly active antiretroviral therapy; HIV; HIV infections; HIV Infections - complications; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Immunosuppressive agents; Inflammation; Inflammation - drug therapy; intraocular inflammation; iru; Lesions; Medical examination; ocular opportunistic infections; ocular syphilis; ocular tb; ocular toxoplasmosis; Patient outcomes; Physiological aspects; retinopathy; Review; Syphilis; Toxicity; Uveitis; Uveitis - diagnosis; Uveitis - drug therapy
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/ijo.IJO_1248_20

Intraocular inflammation in patients with human immunodeficiency virus (HIV) infection is commonly due to infectious uveitis. Ocular lesions due to opportunistic infections (OI) are the most common and have been described extensively in the pre highly active antiretroviral therapy (HAART) era. Many eye lesions were classified as acquired immunodeficiency syndrome (AIDS) defining illnesses. HAART-associated improvement in immunity of the individual has changed the pattern of incidence of these hitherto reported known lesions leading to a marked reduction in the occurrence of ocular OI. Newer ocular lesions and newer ocular manifestations of known agents have been noted. Immune recovery uveitis (IRU), the new menace, which occurs as part of immune recovery inflammatory syndrome (IRIS) in the eye, can present with significant ocular inflammation and can pose a diagnostic and therapeutic challenge. Balancing the treatment of inflammation with the risk of reactivation of OI is a task by itself. Ocular involvement in the HAART era can be due to the adverse effects of some systemic drugs used in the management of HIV/AIDS. Drug-associated retinal toxicity and other ocular side effects are being increasingly reported. In this review, we discuss the ocular manifestations in HIV patients and its varied presentations following the introduction of HAART, drug-associated lesions, and the current treatment guidelines.