Causes of uveitis in HIV positive patients
| Location/cause | Distinguishing features |
| Anterior uveitis | |
| Herpetic anterior uveitis (VZV, HSV)3 5 | Any CD4+ cell count. Prior or concurrent dermatitis, blepharoconjunctivitis, keratitis, or encephalitis. Often associated with decreased corneal sensation, elevated intraocular pressure, or patchy or sectoral iris atrophy. Almost always unilateral. |
| Cidofovir associated uveitis10-12 | CD4+ cell count usually less than 50 cells ×106/l. Risk may increase with HAART and rising CD4+ cell counts. Often granulomatous and associated with posterior synechiae. May be accompanied by hypotony. More common in eyes with inactive CMV retinitis. Dose related. May be unilateral or bilateral. |
| Rifabutin associated uveitis9 | CD4+ cell count usually less than 50 cells ×106/l. Often associated with hypopyon. Dose related. Serum concentration and risk increase with concurrent use of antifungal azole agents and some protease inhibitors. May be unilateral or bilateral. |
| Intermediate and diffuse uveitis | |
| Necrotising herpetic retinitis (CMV, VZV, HSV)3-5 | CD4+ cell counts usually less than 50 cells ×106/l. CMV retinitis is the most common opportunistic infection in HIV positive patients, and typically has one or two foci of active retinitis with mild vitreous inflammation. VZV and HSV retinitis, by contrast, occur in less than 5% of HIV positive patients. Intraocular pressure may be elevated, and the retinitis is typically rapidly progressive with large, confluent or multiple areas of retinitis. |
| Toxoplasmic retinochoroiditis20 | CD4+ cell count usually less than 250 cells ×106/l. Rapid onset. Occurs in up to 10% of HIV positive patients in some parts of the world. Intraocular pressure may be elevated. Typically a single focus of retinitis with adjacent or nearby retinochoroidal scars. Vitreous inflammation is often moderate to severe. Usually unilateral, although bilateral cases have been described. |
| Intraocular lymphoma6 | CD4+ cell counts usually less than 50 cells ×106/l. Insidious onset. Vitritis, retinitis, or retinal vasculitis transiently or incompletely responsive to corticosteroids. May be unilateral or bilateral. Vitreous or retinal biopsy usually required to make the diagnosis. |
| Endogenous endophthalmitis3 | Any CD4+ cell count. Usually rapid onset with moderate to severe vitritis, often with one or more foci of retinitis or a subretinal abscess. Most common in injecting drug users. |
| Immune recovery uveitis13-15 | Improving CD4+ cell count in the setting of HAART. Observed in eyes with inactive CMV retinitis. Inflammation is usually most heavy in the vitreous cavity but may also involve the anterior chamber. Common complications include cystoid macular oedema, epiretinal membrane formation, vitreomacular traction syndrome, retinal neovascularisation, and cataract. |
| HIV associated uveitis7 | CD4+ cell count usually less than 50 cells ×106/l. Usually mild to moderate severity in eyes with no evidence of active retinitis. May be anterior, intermediate, or diffuse. Responds to antiretroviral therapy. |
| Posterior uveitis | |
| Pneumocystis cariniichoroiditis3 22 | CD4+ cell count usually less than 250 cells ×106/l. Usually a bilateral, multifocal choroiditis with little vitreous inflammation. Foci of choroiditis seldom cause haemorrhage in the overlying retina. |
| Cryptococcal choroiditis3 22 | CD4+ cell count usually less than 50 cells ×106/l. Usually a bilateral, multifocal choroiditis with little vitreous inflammation. Foci of choroiditis may cause haemorrhage in the overlying retina. Meningeal involvement with secondary elevated intracranial pressure and optic disc oedema may occur. |
↵HIV positive patients may develop forms of uveitis also seen in immunocompetent patients, including idiopathic anterior uveitis, idiopathic intermediate uveitis (pars planitis), anterior uveitis associated with the seronegative spondyloarthropathies in the presence or absence of HLA-B27 positivity (ankylosing spondylitis, Reiter's syndrome, inflammatory bowel disease, psoriatic arthritis), sarcoid uveitis, syphilitic uveitis, tuberculous uveitis, and other less common causes of uveitis.3 17-19 23 24
↵As defined by the International Uveitis Study Group.25
↵Varicella zoster virus (VZV) associated eye disease is more common in HIV infected patients, whereas herpes simplex virus (HSV) related infections appear not to occur more frequently. HSV infections may, however, be more severe and more difficult to control in immunocompromised patients.3
↵Endogenous endophthalmitis appears to be related mostly to injecting drug use.