Acute retinal necrosis in the course of AIDS: Study of 26 cases

Objective: To report 26 cases of acute retinal necrosis (ARN) in HIV-infected patients, to compare these data with the literature and to discuss the clinical spectrum of ARN during HIV infection. Design and setting: Twenty-six HIV-infected patients with ARN, collected from five ophthalmology departments in Paris (France) between 1985 and 1993, were analysed retrospectively. Patients: Twenty-eight patients were enrolled; two were lost of follow-up. Diagnosis of ARN was established on the following criteria: (1) inflammation of the anterior segment and the characteristic triad, and (2) peripheral circular necrosis with centripetal progression toward the posterior pole associated with occlusive periarteritis and inflammation of the vitreous. Results: ARN is a late event in the course of immunosuppression (CD4+ lymphocyte count < 100 x 10(6)/l). The most frequent presenting syndrome is a decrease of visual acuity, but signs related to a retrobulbar optic neuritis may also be present. In 60-90% Of cases, vesicular viral eruption, usually shingles, precedes the onset of ARN by several days. Occasionally, neurological impairment is also present. Progression to blindness occurs in 76-85% of cases, bilaterally in 59%, and is usually induced by retinal detachment. This study and literature data suggest that varicella tester virus (VZV) is directly implicated in the onset of ARN. At present, the most efficient therapeutic schedule is unknown. Conclusion: ARN is a rare and serious disease in AIDS patients. It is often associated with VZV infection. There is no preventive or curative efficient treatment. ARN might be considered as another opportunistic infection because of its rapid clinical evolution and severe prognosis.