Failure of antiretroviral therapy to control Varicella zoster retinitis.

The term necrotizing herpetic retinopathies encompasses a spectrum of diseases which includes cytomegalovirus (CMV) retinitis, acute retinal necrosis (ARN) and Varicella zoster retinitis (VZR). Varicella zoster retinitis is a rapidly progressive, necrotizing condition most commonly reported in patients with AIDS. A case of vitreous biopsy-proven VZR is reported in a patient with AIDS that progressed despite immune recovery on highly active antiretroviral therapy (HAART) to a viral load < 50 copies/mL and a CD4 count of 230 cells/microL. This is in contrast to CMV retinitis in which maintenance therapy appears unnecessary once the CD4 count rises and the viral load falls on HAART. Patients with VZR and AIDS should therefore be monitored for reactivation of retinal disease despite HAART-induced remission.