Human Immunodeficiency Virus

The Human Immunodeficiency Virus (HIV) is an infection that is spread through certain body fluids and attacks the body’s immune system, thereby limiting the body’s ability to ward off infection and disease. Ocular manifestations in HIV can occur in up to 70–80 % of untreated HIV infected persons—more than half of which are associated with uveitis. There are many processes by which uveitis can present in HIV. The most common conditions causing uveitis in HIV infected persons is from opportunistic infections (Cytomegalovirus, Herpes zoster opthalmicus, toxoplasmosis, etc.), but it can also occur with ocular neoplasms associated with HIV infection, inflammation secondary to the HIV infection itself, HIV drug toxicity, or paradoxically, to recovery of the immune system during HIV treatment (Immune Recovery Uveitis, IRU). The diagnosis is established with a thorough history and physical exam, followed by appropriate serologic or aqueous/vitreous testing. Treatment also depends on etiology—antiretroviral therapy to encourage immune reconstitution, specific antiviral, antimicrobial or antineoplastic therapy, discontinuation of identified drug toxicities, and/or corticosteroids combined with cytotoxic or biologic agents.