Uveitis in HIV positive patients

The dawn of the 21st century brings with it the sobering realisation that the human immunodeficiency virus (HIV) epidemic continues to exact an enormous human, social, and economic toll on the world.1 2 As of December 1999, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organisation (WHO) estimated that nearly 34 million people are infected by HIV worldwide, and stated further that the prevalence of HIV infection continues to rise at an alarming rate, perhaps doubling early in this century. While more than 95% of all HIV positive people live either in sub-Saharan Africa or south or South East Asia, most parts of the world have been affected to a greater or lesser extent. Latin America, eastern Europe, and central Asia, for example, each have rapidly growing HIV positive populations which together now approach 2 million, and North America and Western Europe both report in excess of 900 000 and 500 000 HIV positive people, respectively, despite well developed and long standing prevention programmes. To compound matters, it has been estimated that nearly 50% of HIV positive people in the industrialised world, and more than 90% of HIV infected people in developing nations, are unaware of their HIV status.

Ocular complications occur in up to 70%–80% of untreated HIV infected patients, and more than half of these are associated with intraocular inflammation or uveitis (Table 1).3 Conditions associated with uveitis in HIV positive patients include opportunistic infections, such as cytomegalovirus (CMV) retinitis4 and herpes zoster ophthalmicus (HZO),5 unusual neoplasms, such as intraocular lymphoma,6 and possibly inflammation due to HIV infection itself.7 These complications are usually observed during advanced stages of disease, most often as CD4+ T lymphocyte counts drop below 50 cells ×10⁶/l.8 In addition, HIV positive patients …