LETTER TO EDITOR
|Year : 2002 | Volume
| Issue : 3 | Page : 251-2
Acute retinal necrosis and HIV
N Mukerji, Mayank S Pangtey, S Khokhar
Keywords: Eye Infections, Viral, pathology, virology, HIV Infections, pathology, virology, HIV-1, Humans, Retinal Necrosis Syndrome, Acute, pathology, virology,
|How to cite this article:|
Mukerji N, Pangtey MS, Khokhar S. Acute retinal necrosis and HIV. Indian J Ophthalmol 2002;50:251
We read with interest the article by Biswas et al on the ocular lesions in HIV. The authors need to be complemented for this very comprehensive and informative work. We would like to raise a few pertinent issues in this regard.
The authors have clearly pointed out the difference between "three types of viral retinitis in AIDS" in [Table:6]; however it must be realized that despite these subtle differences, the clinical differentiation is not as straightforward. In fact ARN and PORN are probably the continuum of the same disease, which could well, be termed collectively as "Necrotizing Herpetic Retinopathy" (NHR). Friedlander et al have used the term "ARN in patients with AIDS" to describe the entity of PORN.
The [Table:1] mentions the immune status of patients of ARN as "Healthy/rarely immunosuppressed" while describing its manifestations in AIDS which by definition is a count of less than 200/ml thereby CD implying gross immunosuppression.
Going by the table1 one also gets the impression that ARN patients in AIDS commonly have optic nerve involvement whereas patients of PORN in HIV do not have it. It must be clarified that Retrobulbar Optic Neuritis (RBON) can infrequently herald the onset of ARN in immunocompromised patients but it is certainly not common in this group as compared to immunocompetent patients. In fact Engstrom et al have defined optic neuropathy as a supporting feature of ARN, but not in immunocompromised patients, in the diagnostic criteria stated by them in defining the clinical differences between ARN in immunocompetent and immunocompromised patients. Moreover Batisse et al in their series of 26 cases of ARN in HIV have reported RBON in just four patients. However, both Batisse et al, and Friedlander et al do mention "optic nerve involvement" in the form of inflammatory cells or infarction of the nerve, which commonly progressed to late atrophy.
We believe that ARN and PORN must be projected as manifestations of the same entity, NHR, ARN being a disease of immunocompetent people and PORN that of immunosuppressed, the differences in clinical manifestations probably because of the lack of cell mediated inflammatory response in immunosuppressed patients. Also it must be kept in mind that RBON heralds ARN more commonly in immunocompetent people even though such reports do exist for immunosupressed patients.
| References|| |
|1.||Biswas J, Fogla R, Gopal L, Narayana KM, Banker AS, Kumaraswamy N, et al. Current approaches to diagnosis and management of ocular lesions in human immunodeficiency virus positive patients. Indian J Ophthalmol 2002;50:83-96. |
|2.||Engstrom RE, Holland GN, Margolis TP, Muccioli C, Lindley JI, Belfort R Jr. The progressive outer Retinal Necrosis syndrome: A variant of necrotizing herpetic retinopathy in patients with AIDS. Ophthalmology 1994;101:1488-1502. |
|3.||Friedlander SM, Rahhal FM, Ericson L, Arrevalo JF, Hughes JD, Levi L, et al. Optic neuropathy preceding acute retinal necrosis in acquired Immunodeficiency Syndrome. Arch Ophthalmol 1996;114:1481-85. |
|4.||Batisse D, Eliaszewicz M, Zazoun L, Baudrimont M, Pialoux G, Dupont B. Acute retinal necrosis in the course of AIDS: study of 26 cases. AIDS 1996;10:55-60. [PUBMED] |