Highly active antiretroviral therapy-induced immune recovery in an HIV-positive patient with a history of herpes zoster ophthalmicus

BACKGROUND: With the introduction of highly active antiretroviral therapy (HAART), the incidence of opportunistic infections in human immunodeficiency virus (HIV)-positive patients has dramatically decreased; however, clinicians should be made aware of the clinical presentation of immune recovery mediated HAART induced ocular inflammation. This case report discusses the correlation of HAART induction with immune recovery and ocular inflammation in an HIV-positive patient with a history of herpes zoster ophthalmicus (HZO). CASE REPORT: An HIV-positive man presented with a chief complaint of headache, severe facial pain, swollen eyelid, and light sensitivity in the right eye. The patient indicated the ocular discomfort was similar to his HZO outbreak treated successfully 3 months prior. He recently was initiated on HAART by his infectious disease specialist. The patient's diagnosis was immune recovery mediated HAART induced ocular inflammation associated with HZO. CONCLUSION: HAART has significantly reduced HIV-related morbidity and mortality, but new complications have emerged. Recognition of immune reconstitution inflammatory syndrome and the correlation with ocular inflammation is critical because treatment is based on protecting the patient against the effects of the inflammatory response without compromising antimicrobial or antiviral therapy. Optometry 2011;82:77-82