Ocular Manifestations of Immune Reconstitution Inflammatory Syndrome in HIV after Highly Active Antiretroviral Therapy: Clinical Use of CD8+ T cell.

Abstract

Purpose: To investigate ocular manifestation of immune reconstitution inflammatory syndrome (IRIS) in human immunodeficiency virus (HIV) patients after starting highly active antiretroviral therapy (HAART) and its relationship to T cell immunity.

Methods: 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.

Results: 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). Cut-off 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.

Conclusions: There was 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.