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HIV Retinopathy

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Albert and Jakobiec's Principles and Practice of Ophthalmology

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Abstract

Human Immunodeficiency Virus (HIV) retinopathy, also called Acquired Immunodeficiency Syndrome (AIDS) retinopathy, is a noninfectious retinal microvasculopathy and the most common ocular manifestation of HIV infection. Its primary significance is the strong correlation with the degree of immunosuppression, occurring in over 50% of patients with AIDS (acquired immunodeficiency syndrome). While HIV retinopathy does not by itself constitute AIDS, it is typically found in patients with a CD4+ T-lymphocyte count (CD4+ count) of <200 cells/mL, which is an AIDS-defining condition and a level of immunosuppression at which ocular opportunistic infections such as cytomegalovirus (CMV) retinitis become much more common. HIV retinopathy is characterized by cotton wool spots (the most common manifestation), dot-blot and flame-shaped hemorrhages, white-centered hemorrhages, and capillary nonperfusion. Cotton wool spots have a white, feathery appearance, may be single or multiple, and usually vary from 150 to 350 microns in size and are confined to the posterior pole. They are usually asymptomatic. HIV retinopathy has a lengthy differential diagnosis. Reversal of HIV retinopathy may be a helpful sign of a positive response to combination antiretroviral therapy (cART), and widespread use of cART since the 1990s has resulted in a much lower incidence of both HIV retinopathy and ocular opportunistic infections. However, as AIDS has evolved from a terminal into a chronic and manageable disease, it is clear that HIV infection causes chronic inflammation and immune activation that may cause accelerated aging despite continued viral suppression. Accelerated biological aging may include a neurocognitive decline in HIV-infected individuals. Functional and structural retina changes in the absence of ocular opportunistic infections or visible noninfectious HIV retinopathy may manifest as subtle diminution in contrast sensitivity, visual field defects, and thinning of the peripapillary retinal nerve fiber layer, collectively known as “HIV-associated neuroretinal disorder” (HIV-NRD). Studies have suggested that HIV-NRD increases the risk for visual impairment, blindness, decreased quality of life, and even mortality. Thus, techniques for identifying HIV-NRD will become increasingly important in the management of individuals living with HIV/AIDS.

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Authors and Affiliations

  1. Uveitis Unit, Retina Division, Wills Eye Hospital, Philadelphia, PA, USA

    James P. Dunn

  2. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    James P. Dunn

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  1. James P. Dunn
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Correspondence to James P. Dunn .

Editor information

Editors and Affiliations

  1. Casey Eye Institute, Oregon Health & Science, Portland, OR, USA

    Daniel M. Albert

  2. Department of Ophthalmology, Massachusetts Eye and Ear, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Joan W. Miller

  3. Department of Ophthalmology, University of Illinois College of Medicine, University of Illinois at Chicago, Chicago, IL, USA

    Dimitri T. Azar

  4. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA

    Lucy H. Young

Section Editor information

  1. Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA

    Ivana Kim Prof

  2. Massachusetts Eye and Ear, Boston, USA

    Yoshihiro Yonekawa

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Dunn, J.P. (2022). HIV Retinopathy. In: Albert, D.M., Miller, J.W., Azar, D.T., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-030-42634-7_32

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  • DOI: https://doi.org/10.1007/978-3-030-42634-7_32

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