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immune reconstitution syndrome- causing blindness!!!??how common is this?
Mar 4, 2006

hey,

i'm a 4th year med student from south africa. During my opthalmology rotation I have seen many patients on ARV's with really nasty side-effects,but not to the drugs themselves....(presumably due to immune reconstitution syndrome) The most disturbing was a 30 year old woman who started med's july '05 with a CD4 count of 17(at the time however,she felt totally healthy and was havind no clinical signs of AIDS. Three months on meds and she got a CMV retinitis which led to a retinal detachment causing irreversible blindness!!!

so she went from not knowing her HIV status and feeling healthy(despite her low CD4 count) to discovering her status, starting meds and going blind! she blames the drugs, and situations like this can obviously cause major adherence problems! also, with our politial climate(or health minister) leaning towards dissidence, these types of reactions are very damageing to the fight against HIV and AIDS.

how commonly do patients on meds have such severe reactions? And what can be done to minimize the risk???(aside from regular assessment which is not always possible)

thanks!

Response from Dr. Henry

Very good question. Starting treatment earlier as a general policy/practice (with a higher CD4 count) is important. It is standard of care in the US to have a good retina examination looking for even subtle CMV retinitis in patients with CD4 count < 50-100. Perhaps treating any diagnosed OI for a brief period befor starting HIV meds may help (studies are trying to address that). In the old days of AIDS I had scores of patients develop CMV retinitis with many losing their vision so that is a part of the background assortment of serious problems effective HIV treatment avoids when started at a higher CD4 count. It is unclear how to best manage immune reconstitution syndrome once it has developed. Ophthalmologists used to be one of the most important specialist for the care of AIDS patients and in many settings that is still true. KH



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