Korean J Ophthalmol.  2025 Feb;39(1):71-79. 10.3341/kjo.2024.0133.

Ocular Manifestations of Immune Reconstitution Inflammatory Syndrome in HIV after Highly Active Antiretroviral Therapy: Clinical Use of CD8+ T cell

• Kim JH
• Cho MH
• Ban JH
• Lee SH
• Lee JS

• KMID: 2564134
• DOI: http://doi.org/10.3341/kjo.2024.0133

Abstract

Purpose
To investigate ocular manifestation of immune reconstitution inflammatory syndrome (IRIS) in HIV patients after starting highly active antiretroviral therapy (HAART) and its relationship to T cell immunity.
Methods
HIV patients with ocular IRIS after HAART were retrospectively reviewed. Clinical presentations with previous opportunistic infection, duration from initiation of HAART to IRIS, blood CD4+, CD8+ T cell count, and HIV RNA copies before HAART and at IRIS were analyzed.
Results
Among 19 patients (27 eyes) included, the most common previous opportunistic infection was cytomegalovirus (17 patients, 89.5%) followed by tuberculosis choroiditis (2 patients, 10.5%). The clinical manifestations included vitritis (20 eyes, 74.0%), retinitis (14 eyes, 51.9%), and anterior uveitis (5 eyes, 18.5%). The median duration from initiation of HAART to IRIS was 70 days. CD4+ T cell count before HAART increased at IRIS (p < 0.001). CD8+ T cell count before HAART was negatively correlated with duration from HAART to IRIS (p < 0.001). The cutoff value of CD8+ T cell count for discerning early or late onset of ocular IRIS was 258/mm³ (p = 0.001). When divided into two groups by CD8+ T cell count of 258/mm³, 90% patients with CD8+ T cell count higher than 258/mm³ before HAART developed ocular IRIS within 70 days.
Conclusions
There was a negative relationship between CD8+ T cell count before HAART and duration from HAART to ocular IRIS. Ocular IRIS with higher CD8+ T cell count before HAART developed earlier after HAART initiation compared to those with lower CD8+ T cell count.

Keyword

CD8+ T cell; Cytomegalovirus retinitis; HIV; Immune reconstitution inflammatory syndrome