To investigate the clinical characteristics, risk factors and prognosis of immune recovery uveitis (IRU) of patients with acquired immunodeficiency syndrome (AIDS) and cytomegalovirus retinitis during antiretroviral therapy (ART).

The clinical data of 31 AIDS patients with IRU diagnosed in Ophthalmology Department of Beijing Ditan Hospital, Capital Medical University from February 2014 to February 2019 were analyzed, retrospectively, including the time interval between ART and IRU, symptoms and signs of IRU, best corrected visual acuity, slit lamp microscope examination of anterior segment, mydriatic fundus examination and color fundus photography, frequency domain OCT measurement of macula, CD4⁺ T lymphocyte count before ART and during IRU. Logistic regression analysis was used to analyze the related factors influencing the visual acuity of patients with IRU.

Among the 31 patients, 27 (87.09%) patients were male, 21 (67.75%) patients with bilateral disease, 31 (59.62%) eyes had vitreous opacity, and 26 (50.00%) eyes had anterior uveitis. Eleven (21.15%) eyes had cataract, 8 (15.38%) eyes had macular edema, 3 (5.77%) eyes had optic papillitis, and 3 (5.77%) eyes had epimacular membrane. The median number of CD4⁺ T lymphocytes was 21 cells/μl when ART treatment started. The median number of CD4⁺ T lymphocytes was 180 cells/μl when IRU occurred. The median interval between ATR treatment and IRU was 31 weeks. Twenty-four (44.23%) eyes located in zone 1, 14 (26.92%) eyes located in zone 2 and 15 (28.85%) eyes located in zone 3. The range of fundus lesions was less than 25% in 11 (21.15%) eyes, 25 (48.08%) eyes had fundus lesions ranging from 25% to 50%, and 16 (30.77%) eyes had fundus lesions larger than 50%. The visual acuity of 11 (21.15%) eyes decreased, 15 (28.85%) eyes remained unchanged and 26 (50.00%) eyes improved when followed-up at 6 months. Univariate analysis showed that there were significant differences in the changs of CD4⁺ T lymphocyte count, CMVR fundus lesion area and the zone of CMVR among different vision groups (P = 0.014, 0.007, 0.005). Multivariate Logistic regression analysis showed that the change of CD4⁺ T lymphocyte count and the zone of CMVR were independent factors affecting the improvement of visual acuity. The chance of vision improvement was 1.03 times (95%CI: 1.01-1.05, OR = 1.03, P = 0.004) based on each increase of CD4⁺ T lymphocyte (count/μl). The rate of vision improvement in CMVR patients with fundus lesions in zone 3 was 6.89 times higher than that in zone 1 (95%CI: 1.38-34.37, OR = 6.89, P = 0.018).

The most common clinical features of IRU were anterior uveitis and vitritis. The improvement of visual acuity was correlated with the zone of involvement of CMVR and the absolute change of CD4⁺ T lymphocyte counts at IRU and at ART commencement.