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Acute retinal necrosis in the course of AIDS: study of 26 cases
D Batisse1, M Eliaszewicz, L Zazoun
1Infectious Disease Department, Pasteur Institute Hospital, Paris, France.
Objective:
To report 26 cases of acute retinal necrosis (ARN) in HIV-infected patients, to compare these data with the literature and to discuss the clinical spectrum of ARN during HIV infection.
Design And Setting:
Twenty-six HIV-infected patients with ARN, collected from five ophthalmology departments in Paris (France) between 1985 and 1993, were analysed retrospectively.
Patients:
Twenty-eight patients were enrolled; two were lost of follow-up. Diagnosis of ARN was established on the following criteria: (1) inflammation of the anterior segment and the characteristic triad, and (2) peripheral circular necrosis with centripetal progression toward the posterior pole associated with occlusive periarteritis and inflammation of the vitreous.
Results:
ARN is a late event in the course of immunosuppression (CD4+ lymphocyte count < 100 x 10(6)/l). The most frequent presenting syndrome is a decrease of visual acuity, but signs related to a retrobulbar optic neuritis may also be present. In 60-90% of cases, vesicular viral eruption, usually shingles, precedes the onset of ARN by several days. Occasionally, neurological impairment is also present. Progression to blindness occurs in 76-85% of cases, bilaterally in 59%, and is usually induced by retinal detachment. This study and literature data suggest that varicella zoster virus (VZV) is directly implicated in the onset of ARN. At present, the most efficient therapeutic schedule is unknown.
Conclusion:
ARN is a rare and serious disease in AIDS patients. It is often associated with VZV infection. There is no preventive or curative efficient treatment. ARN might be considered as another opportunistic infection because of its rapid clinical evolution and severe prognosis.
Insights
Acute retinal necrosis (ARN) is a severe opportunistic infection in HIV-infected patients, often caused by varicella zoster virus (VZV). This condition leads to rapid vision loss and blindness, with no effective treatment currently available.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Virology
Background:
- Acute retinal necrosis (ARN) is a rare but severe ocular condition.
- Human immunodeficiency virus (HIV) infection is associated with various opportunistic infections affecting the eyes.
- Understanding ARN in HIV patients is crucial for managing vision loss.
Observation:
- A retrospective analysis of 26 HIV-infected patients with ARN was conducted.
- ARN presented as a late complication of immunosuppression (CD4+ < 100 cells/µL).
- Varicella zoster virus (VZV) was implicated in the majority of cases, often preceded by shingles.
Findings:
- Common symptoms include decreased visual acuity and retrobulbar optic neuritis.
- High rates of blindness (76-85%) and bilateral involvement (59%) were observed.
- Retinal detachment frequently led to vision loss.
Implications:
- ARN should be considered an opportunistic infection in advanced HIV/AIDS.
- Early diagnosis and management are critical, though effective treatments remain elusive.
- Further research is needed to develop preventive and curative strategies for ARN in immunocompromised individuals.