Before the advent of highly active antiretroviral therapy (HAART), uveitis, in particular cytomegalovirus (CMV) retinitis, was the most common cause of visual loss in patients with AIDS. HAART has altered the cause of ocular disease in HIV infected individuals by elevating the CD4 cell count. However, uveitis still occurs in this group of patients. The aim of this retrospective case series was to ascertain the spectrum of uveitis conditions in HIV infected individuals presenting with ocular inflammation when the peripheral CD4+ T lymphocyte count was over 200 cells/µL. Sixty-one patients were included in this study from seven tertiary referral inflammatory eye disease clinics in the USA. The median CD4 cell count at presentation of uveitis was 421 cells/µL. Eighty-two percent of the patients were being treated with HAART. The HIV load varied from undetectable to 137 705 copies/ml. The median was undetectable. Uveitis was unilateral in 47.5% and bilateral in 47.5% of patients. Anterior uveitis was the most common type in 47.5% of patients, followed by anterior / intermediate (16.4%), posterior (14.8%), panuveitis (14.8%), with the least common being intermediate uveitis (6.6%). The cause of the uveitis was infectious in 34.4% of patients and immunological in 27.9%. The most common infectious cause was syphilis in 16.4% of patients followed by herpetic anterior uveitis in 6.6% and acute retinal necrosis in 6.6%. Immune recovery uveitis was the most common defined immunological disorder, with all nine cases associated with previous CMV retinitis. There was no significant difference in the CD4 cell count between the infectious and immunological groups. The authors conclude that in HIV infected patients with a presenting CD4 cell count >200 cells/µL, the anatomical location of uveitis is in a similar distribution to the general uveitis population, but infectious causes of uveitis are more common (34.4% vs 15.4%), particularly ocular syphilis (16.4% vs <2%). 

Uveitis in human immunodeficiency virus-infected persons with CD4+ T-lymphocyte count over 200 cells/µL.
Rose-Nussbaumer J, Goldstein DA, Thorne JE, et al.
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Anjali Gupta

Birmingham and Midland Eye Centre, Birmingham, UK.

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