HIV感染之眼後房臨床表現

Posterior Segment Ocular Manifestations in Patients with HIV Infection

在2013年年底，全世界已有超過3,500萬人感染HIV，當免疫下降至CD4+ T-淋巴球低於200cells/uL時，即稱為AIDS階段，可招致許多伺機感染。據估計，約有70％~80％的HIV患者最後會產生眼部病變。最常見的AIDS眼部病變為CMV視網膜炎及視網膜微血管病變；但仍存有許多續發性感染所產生的合併症，可造成患者的視力喪失，如非CMV壞死性皰疹病毒性視網膜病變及弓漿蟲視網膜脈絡膜炎等。雖然高效能抗反轉錄病毒療法（HAART）已有效地降低HIV感染患者的死亡率，並明顯減少伺機感染的發生率，尤其是CMV視網膜炎，但在AIDS患者中，CMV視網膜炎與其他續發感染仍然是喪失視力的主要原因，尤其在一些AIDS較盛行且醫療體系相對較落後的地區，常因延遲診斷而產生兩側性的大型嚴重眼部病灶，進而導致視網膜剝離。因此，培養早期診斷HIV相關之眼部伺機感染的能力，才能搶得早期診斷、早期治療或轉介的關鍵時機，以期能減少嚴重合併症及喪失視力的結果。本文整理並敘述HIV感染及AIDS患者常見之眼部伺機感染的病源、眼底徵狀及其眼後房臨床表現的病變特徵，並呈現HIV感染者相關之眼後房感染的合併症及其處置。

Globally, there were an estimated 35 million people living with HIV infections at the end of 2013. The later stages of HIV infection, clinically termed as AIDS, are defined as when CD4+ T-lymphocytes are profoundly diminished(< 200 cells/uL), or when opportunistic infections have developed. Overall, 70%~80% of patients with HIV eventually develop ocular manifestation. The most common ocular manifestations of AIDS are CMV retinitis and retinal microvasculopathy. However, there are also many other complications that can cause loss of vision, such as non-CMV necrotizing herpetic retinopathy and toxoplasmic retinochoroiditis. Highly active antiretroviral therapy(HAART) has changed the observed ocular presentation of AIDS, resulting in fewer opportunistic infections, and reduced mortality. This has been reflected inthe occurrence rates of CMV retinitis and other HIV/AIDS-associated ocular infections. However, even with these vast improvements,ocular complications continue to occur, with CMV retinitis continuing to be the most common ocular opportunistic infection in AIDS patients and an important cause of blindness in many developed countries. Usually, people who develop larger lesions and bilateral disease at the time of diagnosis of HIV-related retinopathy, both of which indicate late-stage disease, are predictive of a retinal detachment. Efforts to expand the diagnostic capacity for HIV-related ocular manifestations may lead to earlier detection and treatment, thereby reducing retinal detachment and blindness in these patients. This review will present the key clinical features, pathological changes and complications of the most common ocular opportunistic infections among patients with HIV infection /AIDS, as well as the main issues in their management.