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Uveitis in patients treated with intravenous cidofovir
I Cochereau1, S Doan, M C Diraison
1Service d'Ophthalmologie, H¿opital Bichat-Claude Bernard, Paris, France. oph.sec@bch.ap-hop-paris.fr
Purpose:
To study the characteristics of uveitis occurring during intravenous cidofovir treatment for CMV retinitis in patients with AIDS.
Patients And Methods:
We retrospectively studied ten cases (16 eyes) of uveitis in patients with CMV retinitis treated with intravenous cidofovir. All the patients had ophthalmologic examinations and, if required, fundus angiographies. The median follow-up was eight months.
Results:
Uveitis occurred after a mean of 8.5 infusions of cidofovir (range 2-17). All ten patients were on protease inhibitors. The mean CD4+ cell count was 92 +/- 51/microl and the median viral load was 3.9 log. All the eyes with uveitis had healed CMV retinitis. The first examination of the involved eyes showed inflammation of the anterior chamber (100%), vitritis (50%), posterior synechiae (75%), and low intraocular pressure (94%). Uveitis did not relapse in the seven patients who stopped cidofovir, whereas it relapsed in two of the three patients who did not stop treatment. At the end of follow-up, permanent posterior synechiae were present in 69% of the involved eyes.
Comments:
Cidofovir therapy necessitates slit-lamp surveillance, especially in patients on HAART. Cidofovir-related uveitis requires a local steroid treatment, but if possible, cidofovir should be withdrawn.