What is the role of acute retinal necrosis in the ocular manifestations of HIV infection?

Updated: Jul 21, 2021
  • Author: Luca Rosignoli, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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ARN is a fulminant retinal vaso-occlusive necrotizing retinitis that may complicate VZV, HSV, or, rarely, CMV infections. HIV-positive patients with ARN tend to have a CD4+ cell count greater than 60/µL and usually have an associated history of VZV or HSV dermatitis.

The underlying pathophysiologic mechanisms for ARN rests on the virulence of these viruses following their reactivation, especially in the immunocompromised host. The severity of ARN depends on the degree of the patient's immunocompromise.

The incidence of VZV-associated retinitis after herpes zoster ophthalmicus in patients who are HIV positive is 4-17%; the frequencies of retinitis associated with HSV or CMV infections are much lower. ARN has been associated with either HSV-1 or HSV-2, with a similar course and severity of the infection as seen in VZV-induced ARN. A 2:1 male-to-female predilection to the occurrence of ARN exists.

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