Cystoid macular oedema in patients with AIDS and cytomegalovirus retinitis on highly active antiretroviral therapy.

EDITOR,—Between 16% and 40% of patients with AIDS develop cytomegalovirus retinitis (CMVR). 2 This typically presents when the CD4+ count drops below 75 cells/μl. Visual loss is usually due to retinal detachment, macular or optic nerve infection, or vascular occlusion. Typically a minimal inflammatory response is mounted. Patients with CMVR not associated with HIV infection may develop a vitritis with cystoid macular oedema (CMO) during immune restoration. With the advent of highly active antiretroviral therapy (HAART) patients with AIDS are enjoying improvement in their immune status, with falling HIV viral loads and rising CD4+ counts. Such patients may mount a significant inflammatory response against CMVR, causing a regression of the CMV infection but a paradoxical visual loss due to the inflammation. We describe two such patients with CMVR and vitritis, who lost vision as a result of CMO.