Risk of Immune Recovery Uveitis in Patients with AIDS and Cytomegalovirus Retinitis

John H. Kempen, Yuan I. Min, William R. Freeman, Gary N. Holland, Dorothy N. Friedberg, Douglas T. Dieterich, Douglas Jabs

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate the prevalence of and risk factors for immune recovery uveitis (IRU) in eyes of patients with AIDS and cytomegalovirus (CMV) retinitis. Design: Enrollment data from a 19-clinical center cohort study. Participants: Three hundred seventy-four patients with AIDS and CMV retinitis affecting 539 eyes. Methods: Patients with AIDS were enrolled at 19 United States AIDS ophthalmology clinics. Data were collected by interview, review of medical records, ophthalmic examination, and phlebotomy. Main Outcome Measure: Immune recovery uveitis. Results: Thirty-six patients (9.6%) were diagnosed with IRU involving 50 eyes. The CD4+ T-cell count of 31 of these had risen by ≥50 cells per microliter above nadir to a level ≥ 100 cells per microliter (immune recovery), making up 17.6% of the patients known to have immune recovery after diagnosis of CMV retinitis (95% confidence interval, 12.3%-24.1%). No patients with IRU were observed to have active retinitis or detectable CMV DNA in peripheral blood (P<0.001 and P<0.001 with respect to patients without IRU). Other factors associated with IRU were ≥25% retinal area (odds ratio [OR], 2.72; P = 0.014) or posterior pole involvement with CMV retinitis (odds ratio, 0.43; P = 0.039), treatment with intravitreous injection of cidofovir (OR, 10.6 with respect to eyes never exposed to intravitreous or IV cidofovir; P<0.001), and male gender (OR, 0.26; P = 0.012). More eyes with IRU had visual acuity (VA) of 20/50 or worse (38.0% vs. 26.3%, P = 0.077) relative to eyes without IRU, but the proportions with VA of 20/200 or worse were similar (14.0% vs. 13.8%, P = 0.96). Eyes with IRU more commonly had cystoid macular edema (CME) (45.5% vs. 3.7%, P<0.001) and epiretinal membrane (48.9% vs. 13.3%, P<0.001) than eyes without IRU. Conclusions: Among eyes of patients with immune recovery, the prevalence of IRU is substantial. Eyes with IRU have a high risk of additional morbidity over and above that seen with CMV retinitis, with several-fold higher risk of CME and epiretinal membrane. Large CMV lesions and use of intravitreous cidofovir are risk factors for IRU.

Original languageEnglish (US)
Pages (from-to)684-694
Number of pages11
JournalOphthalmology
Volume113
Issue number4
DOIs
StatePublished - Apr 1 2006

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AIDS-Related Opportunistic Infections
Phosphorous Acids
Posterior Uveitis
Cytomegalovirus Retinitis
CD4-Positive T-Lymphocytes
Vitreous Body
Cytosine
Uveitis
CD4 Lymphocyte Count
Visual Acuity
Antiviral Agents
Acquired Immunodeficiency Syndrome
Cross-Sectional Studies
Injections
Odds Ratio
Epiretinal Membrane
Macular Edema
Cytomegalovirus
Retinitis
Phlebotomy

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Kempen, J. H., Min, Y. I., Freeman, W. R., Holland, G. N., Friedberg, D. N., Dieterich, D. T., & Jabs, D. (2006). Risk of Immune Recovery Uveitis in Patients with AIDS and Cytomegalovirus Retinitis. Ophthalmology, 113(4), 684-694. https://doi.org/10.1016/j.ophtha.2005.10.067

Risk of Immune Recovery Uveitis in Patients with AIDS and Cytomegalovirus Retinitis. / Kempen, John H.; Min, Yuan I.; Freeman, William R.; Holland, Gary N.; Friedberg, Dorothy N.; Dieterich, Douglas T.; Jabs, Douglas.

In: Ophthalmology, Vol. 113, No. 4, 01.04.2006, p. 684-694.

Research output: Contribution to journalArticle

Kempen, JH, Min, YI, Freeman, WR, Holland, GN, Friedberg, DN, Dieterich, DT & Jabs, D 2006, 'Risk of Immune Recovery Uveitis in Patients with AIDS and Cytomegalovirus Retinitis', Ophthalmology, vol. 113, no. 4, pp. 684-694. https://doi.org/10.1016/j.ophtha.2005.10.067
Kempen JH, Min YI, Freeman WR, Holland GN, Friedberg DN, Dieterich DT et al. Risk of Immune Recovery Uveitis in Patients with AIDS and Cytomegalovirus Retinitis. Ophthalmology. 2006 Apr 1;113(4):684-694. https://doi.org/10.1016/j.ophtha.2005.10.067
Kempen, John H. ; Min, Yuan I. ; Freeman, William R. ; Holland, Gary N. ; Friedberg, Dorothy N. ; Dieterich, Douglas T. ; Jabs, Douglas. / Risk of Immune Recovery Uveitis in Patients with AIDS and Cytomegalovirus Retinitis. In: Ophthalmology. 2006 ; Vol. 113, No. 4. pp. 684-694.
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abstract = "Objective: To evaluate the prevalence of and risk factors for immune recovery uveitis (IRU) in eyes of patients with AIDS and cytomegalovirus (CMV) retinitis. Design: Enrollment data from a 19-clinical center cohort study. Participants: Three hundred seventy-four patients with AIDS and CMV retinitis affecting 539 eyes. Methods: Patients with AIDS were enrolled at 19 United States AIDS ophthalmology clinics. Data were collected by interview, review of medical records, ophthalmic examination, and phlebotomy. Main Outcome Measure: Immune recovery uveitis. Results: Thirty-six patients (9.6{\%}) were diagnosed with IRU involving 50 eyes. The CD4+ T-cell count of 31 of these had risen by ≥50 cells per microliter above nadir to a level ≥ 100 cells per microliter (immune recovery), making up 17.6{\%} of the patients known to have immune recovery after diagnosis of CMV retinitis (95{\%} confidence interval, 12.3{\%}-24.1{\%}). No patients with IRU were observed to have active retinitis or detectable CMV DNA in peripheral blood (P<0.001 and P<0.001 with respect to patients without IRU). Other factors associated with IRU were ≥25{\%} retinal area (odds ratio [OR], 2.72; P = 0.014) or posterior pole involvement with CMV retinitis (odds ratio, 0.43; P = 0.039), treatment with intravitreous injection of cidofovir (OR, 10.6 with respect to eyes never exposed to intravitreous or IV cidofovir; P<0.001), and male gender (OR, 0.26; P = 0.012). More eyes with IRU had visual acuity (VA) of 20/50 or worse (38.0{\%} vs. 26.3{\%}, P = 0.077) relative to eyes without IRU, but the proportions with VA of 20/200 or worse were similar (14.0{\%} vs. 13.8{\%}, P = 0.96). Eyes with IRU more commonly had cystoid macular edema (CME) (45.5{\%} vs. 3.7{\%}, P<0.001) and epiretinal membrane (48.9{\%} vs. 13.3{\%}, P<0.001) than eyes without IRU. Conclusions: Among eyes of patients with immune recovery, the prevalence of IRU is substantial. Eyes with IRU have a high risk of additional morbidity over and above that seen with CMV retinitis, with several-fold higher risk of CME and epiretinal membrane. Large CMV lesions and use of intravitreous cidofovir are risk factors for IRU.",
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AU - Kempen, John H.

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AU - Freeman, William R.

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AU - Dieterich, Douglas T.

AU - Jabs, Douglas

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N2 - Objective: To evaluate the prevalence of and risk factors for immune recovery uveitis (IRU) in eyes of patients with AIDS and cytomegalovirus (CMV) retinitis. Design: Enrollment data from a 19-clinical center cohort study. Participants: Three hundred seventy-four patients with AIDS and CMV retinitis affecting 539 eyes. Methods: Patients with AIDS were enrolled at 19 United States AIDS ophthalmology clinics. Data were collected by interview, review of medical records, ophthalmic examination, and phlebotomy. Main Outcome Measure: Immune recovery uveitis. Results: Thirty-six patients (9.6%) were diagnosed with IRU involving 50 eyes. The CD4+ T-cell count of 31 of these had risen by ≥50 cells per microliter above nadir to a level ≥ 100 cells per microliter (immune recovery), making up 17.6% of the patients known to have immune recovery after diagnosis of CMV retinitis (95% confidence interval, 12.3%-24.1%). No patients with IRU were observed to have active retinitis or detectable CMV DNA in peripheral blood (P<0.001 and P<0.001 with respect to patients without IRU). Other factors associated with IRU were ≥25% retinal area (odds ratio [OR], 2.72; P = 0.014) or posterior pole involvement with CMV retinitis (odds ratio, 0.43; P = 0.039), treatment with intravitreous injection of cidofovir (OR, 10.6 with respect to eyes never exposed to intravitreous or IV cidofovir; P<0.001), and male gender (OR, 0.26; P = 0.012). More eyes with IRU had visual acuity (VA) of 20/50 or worse (38.0% vs. 26.3%, P = 0.077) relative to eyes without IRU, but the proportions with VA of 20/200 or worse were similar (14.0% vs. 13.8%, P = 0.96). Eyes with IRU more commonly had cystoid macular edema (CME) (45.5% vs. 3.7%, P<0.001) and epiretinal membrane (48.9% vs. 13.3%, P<0.001) than eyes without IRU. Conclusions: Among eyes of patients with immune recovery, the prevalence of IRU is substantial. Eyes with IRU have a high risk of additional morbidity over and above that seen with CMV retinitis, with several-fold higher risk of CME and epiretinal membrane. Large CMV lesions and use of intravitreous cidofovir are risk factors for IRU.

AB - Objective: To evaluate the prevalence of and risk factors for immune recovery uveitis (IRU) in eyes of patients with AIDS and cytomegalovirus (CMV) retinitis. Design: Enrollment data from a 19-clinical center cohort study. Participants: Three hundred seventy-four patients with AIDS and CMV retinitis affecting 539 eyes. Methods: Patients with AIDS were enrolled at 19 United States AIDS ophthalmology clinics. Data were collected by interview, review of medical records, ophthalmic examination, and phlebotomy. Main Outcome Measure: Immune recovery uveitis. Results: Thirty-six patients (9.6%) were diagnosed with IRU involving 50 eyes. The CD4+ T-cell count of 31 of these had risen by ≥50 cells per microliter above nadir to a level ≥ 100 cells per microliter (immune recovery), making up 17.6% of the patients known to have immune recovery after diagnosis of CMV retinitis (95% confidence interval, 12.3%-24.1%). No patients with IRU were observed to have active retinitis or detectable CMV DNA in peripheral blood (P<0.001 and P<0.001 with respect to patients without IRU). Other factors associated with IRU were ≥25% retinal area (odds ratio [OR], 2.72; P = 0.014) or posterior pole involvement with CMV retinitis (odds ratio, 0.43; P = 0.039), treatment with intravitreous injection of cidofovir (OR, 10.6 with respect to eyes never exposed to intravitreous or IV cidofovir; P<0.001), and male gender (OR, 0.26; P = 0.012). More eyes with IRU had visual acuity (VA) of 20/50 or worse (38.0% vs. 26.3%, P = 0.077) relative to eyes without IRU, but the proportions with VA of 20/200 or worse were similar (14.0% vs. 13.8%, P = 0.96). Eyes with IRU more commonly had cystoid macular edema (CME) (45.5% vs. 3.7%, P<0.001) and epiretinal membrane (48.9% vs. 13.3%, P<0.001) than eyes without IRU. Conclusions: Among eyes of patients with immune recovery, the prevalence of IRU is substantial. Eyes with IRU have a high risk of additional morbidity over and above that seen with CMV retinitis, with several-fold higher risk of CME and epiretinal membrane. Large CMV lesions and use of intravitreous cidofovir are risk factors for IRU.

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