Ocular manifestations of AIDS: new considerations for patients using highly active anti-retroviral therapy (HAART)

Highly active anti-retroviral therapy (HAART) effectively restores the immune system and lowers the viral load in patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Since widespread use of HAART drugs began in 1996, many AIDS patients are living longer and enjoying a higher quality of life. The incidence of AIDS-related ophthalmic infections, such as cytomegalovirus (CMV) retinitis, have declined sharply. AIDS patients with CMV are less likely to experience necrotizing retinitis and retinal detachment, once the major causes of vision loss. HAART and immune recovery is now considered the preferred treatment for CMV retinitis. The role of immune recovery vitritis (IRV), a new manifestation of CMV retinitis, is now understood. In patients with pre-existing CMV retinitis who begin HAART the manifestations of an active immune system are seen, as the body is now able to fight the CMV infection. Incidence of Kaposi's sarcoma has declined by an estimated 87% and molluscum contagiosum is seen less frequently in those using HAART. With the clinical picture of ocular AIDS changing, the role of optometry in the management of AIDS patients is also changing.