CMV retinitis or immune reconstitution inflammatory syndrome in patient infected with multidrug resistant HIV?

SummaryAfter the introduction of combination antiretroviral therapy (cART) in HIV-infected patients immune reconstitution inflammatory syndrome (IRIS) can occur. It mainly affects patients with a low CD4 lymphocyte count and high HIV viremia at the begining of antiretroviral treatment. In this article we present the medical history of a patient in whom, during ineffective cART due to multidrug resistent HIV-infection, cytomegaloviral retinitis of both eyes occurred. The treatment including gancyklovir and steroids was introduced. After following four months we did not observe increase in CD4 count, HIV viremia was not fully suppressed but an ophthalmic improvement was seen. Two weeks after reduction the dose of steroids, impairment of visual acuity (Vod = 0.9; Vos = 0.1) and increase of cellular infiltration in the vitreous of both eyes were observed. Interestingly symptoms suggesting IRIS occured in patient without immunological and virusological response to antiretroviral treatment when dose of steroids was reduced.