Severe intraocular inflammation after a change of HAART

Editor,—Patients with previous cytomegalovirus retinitis (CMVR) have been observed to get vitritis, cystoid macular oedema (CMO), and epiretinal membranes after commencing HAART (highly active antiretroviral therapy).1-3 It is postulated that this is due to the improved CD4+ function that occurs with HAART.4 We present a patient with previously treated CMVR and immune recovery vitritis who developed further severe intraocular inflammation 6 weeks after changing HAART. ### CASE REPORT A 43 year old man, diagnosed as HIV positive in 1984, was treated in January 1996 for bilateral CMVR that responded to systemic ganciclovir. In April 1996 he started saquinavir, stavudine, and lamivudine. A viral load was 18 000 copies ×106/l and CD4+ count 40 cells ×106/l. In December 1996 ritonavir was added. In February 1997 he developed immune recovery vitritis in both eyes. Best corrected visual acuities (BCVA) were 6/6, N5 right; 6/6, N8 left. A viral …