Ocular Complications of HIV/AIDS in the Era of HAART

Millena G Bittencourt; Owhofasa O Agbedia; Hong T Liu; Rachel Annam; Yasir J Sepah; Henry Alexander Leder; Raafay Sophie; Mohamed Ibrahim; Abeer Akhtar; Anam Akhlaq; Diana V Do; Quan Dong Nguyen


Expert Rev Ophthalmol. 2012;7(6):555-564. 

In This Article

Ocular Complications of HIV: The Dilemma in the Era of HAART

Fifteen years after the introduction of HAART, the management of ocular HIV complications is still being established. The specific timing of when to initiate HAART in patients with CMVR is still an issue. In 2005, a study conducted by Ortega-Larrocea and colleagues in Mexico showed that patients with CMVR who had early introduction of HAART had a higher incidence of IRU (71%) and also developed more severe IRU than those patients who had completed induction therapy for CMV before initiating HAART (31% of IRU incidence).[96] The data suggested a benefit in delaying the initiation of HAART in controling the CMVR and reducing the chances of IRU. However, the risks of opportunistic infections should be taken into consideration. One randomized trial in which HAART was started approximately 2 weeks after opportunistic infection therapy, in comparison to approximately 6 weeks later, demonstrated a significantly greater risk of AIDS-related events in the latter group.[97] Furthermore, there was no increase in immune reconstitution inflammatory syndrome events in the latter group, although CMVR was not specifically studied. Some authors suggest that because the rate of IRU is low (0.04/PY) and because CMV replication is controlled within 1–2 weeks, a delay of no more than 2 weeks would seem prudent.[1] Overall, the prevalence of CMVR has reduced by 75–90% compared with the pre-HAART era and there has been a 40–50% reduction in the prevalence of opportunistic infections (Table 1).