How is acute retinal necrosis and progressive outer retinal necrosis in HIV infection diagnosed?

Updated: Jul 21, 2021
  • Author: Luca Rosignoli, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Answer

CD4 count can help in distinguishing the etiology of retinitis: ARN can occur in immunocompetent patients, whereas CMV retinitis and PORN are usually associated with immunosuppression. However, the ultimate diagnosis relies on PCR-based analysis of aqueous or vitreous humor, which offers high diagnostic specificity and sensitivity in the diagnosis of VZV, HSV or CMV retinitis. Vitreous sampling is usually reserved for patients with atypical lesions, for individuals in whom disease is not responsive to treatment, or for patients for whom a vitreous biopsy would carry little added risk.

In cases of CMV retinitis, the patient should have a workup for systemic CMV infection that includes testing of urine and serum CMV titers.


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