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Immune Recovery Uveitis — SCE Infectious Diseases MCQ

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HardHIV MedicineImmune Recovery UveitisSCE Infectious Diseases

A 40-year-old man with advanced HIV (CD4 30) develops bilateral retinal detachments following immune reconstitution on ART. He was previously treated for CMV retinitis. What is the mechanism of retinal detachment in this context?

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Correct answer: B — Immune recovery uveitis (IRU) — ART-induced immune reconstitution causes vitritis and traction on retinal scars from prior CMV retinitis, leading to rhegmatogenous retinal detachment

Immune recovery uveitis (IRU) is a form of IRIS affecting the eye. It occurs when immune reconstitution on ART triggers inflammatory responses against residual CMV antigens in previously infected retina. The resulting vitritis creates vitreous traction on atrophic retinal scars (from healed CMV retinitis), causing rhegmatogenous retinal detachment. IRU occurs in 15–25% of patients with prior CMV retinitis who achieve immune reconstitution. Management includes intravitreal or periocular corticosteroids and vitreoretinal surgery for detachment. ART should NOT be stopped.

Reference: BHIVA 2022 – OI guidelines; AAO 2020 – Immune recovery uveitis