What are the other Names for this Condition? (Also known as/Synonyms)

• HIV-Associated Retinopathy
• Human Immunodeficiency Virus Retinopathy
• Retinopathy due to HIV Infection

What is HIV Retinopathy? (Definition/Background Information)

• HIV Retinopathy is an infectious eye disorder that involves the retina and occurs against a background of human immunodeficiency virus (HIV) infection. The condition is frequently observed in HIV/AIDS patients and can result in severe vision impairment and blindness without adequate treatment
• Retinopathy may be described as the acute or chronic damage to retina, secondary to systemic conditions such as diabetes and hypertension. The retina is a layer of tissue situated at the back of the eye and helps in sensing light. When the blood supply to the retina is blocked, it will not be able to receive enough blood and oxygen leading to a loss of vision
• HIV infection is usually acquired through sexual intercourse or exposure to infected blood or body fluids. The condition is characterized by a host of signs and symptoms such as fever, swelling of the lymph nodes, pharyngitis, skin rashes, muscle pain, malaise, and weight loss
• Due to the severely lowered immune function in HIV-infected individuals, a host of opportunistic infections, such as cytomegalovirus infection and toxoplasmosis, and even malignancies may arise that present ocular involvement and retinal damage
• The signs and symptoms of HIV Retinopathy include loss of visual acuity, blurred vision, eye floaters and eye flashes, but are also dependent on the associated conditions/infections. HIV Retinopathy may be diagnosed through retinal examination, blood and body fluid tests, and imaging studies
• Prompt diagnosis and treatment needs to be provided for HIV Retinopathy, in order to prevent complications such as retinal hemorrhages and macular edema. If the condition is not treated with urgency, HIV Retinopathy can lead to total blindness

Who gets HIV Retinopathy? (Age and Sex Distribution)

• HIV Retinopathy is commonly seen in individuals with HIV infection or AIDS, when an involvement of the eye is noted
• Both males and females are affected and no preference is observed
• It is observed worldwide and all racial and ethnic groups may be affected

What are the Risk Factors for HIV Retinopathy? (Predisposing Factors)

Acute human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) is the primary risk factor for the development of HIV Retinopathy.

An HIV infection is known to develop from the following factors:

• Sexual partners of individuals who are infected by HIV
• Individuals having unprotected sex
• Men and women having multiple sex partners
• Men who have sex with men
• Intravenous drug users due to sharing of needles
• Chronic infection by HIV results in AIDS

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of HIV Retinopathy? (Etiology)

HIV Retinopathy may be described as a retinal infection of the eye, which is caused by the human immunodeficiency virus (HIV) that can result in AIDS. Studies show that in nearly 70-80% of the HIV-infected individuals, the eye is affected; and of which, retinopathy is the most common condition.

It is important to note that the retinopathy can be caused in HIV/AIDS due to small blood vessel occlusions/blocks (microvasculopathy), certain opportunistic infections (commonly caused by cytomegalovirus and Toxoplasma gondii), due to malignancy (such as Kaposi sarcoma), and from herpes zoster ophthalmicus (HZO, a condition caused by the reactivation of the chickenpox virus). These develop due to the highly immunocompromised state of the individual.

HIV infection is caused by the human immunodeficiency virus (HIV), a virus that gradually destroys the immune system. The virus spreads in the following manner:

• Through sexual contact
• Contaminated blood transfusions and blood products
• Injections given to patients using contaminated needles and syringes
• An infected pregnant women can pass on the virus to the fetus through the placenta
• In some cases, the virus can spread while breastfeeding

Note: The lower is the CD 4 T lymphocyte count in blood, the higher is the risk for HIV Retinopathy.

What are the Signs and Symptoms of HIV Retinopathy?

The signs and symptoms due to HIV Retinopathy may vary from one individual to another and depends on the type of associated opportunistic infection or condition present. The signs and symptoms of HIV Retinopathy may include:

• Retinal microvasculopathy: Disease of the small blood vessels of the retina is observed in 40% to 70% of the HIV-infected individuals
• Blurring of vision
• Redness of the eye
• Aversion to light (or photophobia)
• Eye pain may be noted
• Eye floaters: The individuals experience illusions that some small objects such as spots, hairs, or strings are moving in the eye
• Flashes in the eye: The sudden appearance of ‘flashing’ bright lights
• Impaired color vision
• Loss of visual acuity is noted in most of the individuals
• Narrowing or constriction of the visual field
• The involvement of one eye (unilateral involvement) or both eyes (bilateral involvement) may be noted

Apart from the above, the signs and symptoms arising from the underlying HIV infection or AIDS and any other associated condition may be observed.

How is HIV Retinopathy Diagnosed?

The various tests and examinations conducted to diagnose HIV Retinopathy may include:

• Complete physical examination and comprehensive medical history
• Thorough eye examination by experts in eye disorders such as ophthalmologists and retinal specialists
• Antibody test or HIV ELISA or Western Blot test: The most common test performed is the antibody test. Enzyme immunoassay (EIA) or ELISA is used to check for antibodies produced in the body against the HIV virus
• HIV RNA test/viral load test: This test will help in detecting the HIV virus and is an important test for diagnosing those who are recently infected
• A variety of tests can be performed on aqueous humor and/or vitreous humor fluid samples that include:
  • Polymerase chain reaction (PCR) studies for viral infections
  • Viral cultures
  • Immunofluorescence studies, direct or indirect, to detect the presence of viruses
  • Blood tests to detect antibodies against viruses
  • Viral antibody titer in aqueous humor and vitreous humor fluid samples
• Specific tests related to the retina such as:
  • A  thorough inspection of the retina after dilating the pupil in both eyes
  • Slit lamp examination: This test uses an instrument that gives a 3-dimensional picture of different parts of the eye
  • Ultrawide field imagint (Optos) can be used to study peripheral involvement of the retina
  • Fundus fluorescein angiogram: In this technique, the eye blood vessels are examined using a fluorescein dye. It can help detect the degree of occlusion of the retinal blood vessels
  • Optical coherence tomography (OCT) of eye: It is a radiological imaging technique to visualize the eye structure
  • Visual field examination: An eye examination that concentrates on checking the abnormality in the central and peripheral vision, which may have been caused by various other medical conditions
  • Visual acuity: Eye test that is performed to check the clearness of vision
• Tests to determine other underlying conditions and opportunistic infections or malignancies may be performed

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of HIV Retinopathy?

The following complications may be noted in individuals with HIV Retinopathy:

• Retinal hemorrhages: A condition that is characterized by bleeding within the retina
• Epiretinal membrane: Development of scar tissue over the surface of the macula
• Macular edema: Fluid accumulation in the macular region of the retina
• Retinal detachment: An eye condition in which the retina gets separated from the eye structures that holds the retinal layers together
• Retinal holes and tears
• Optic nerve atrophy: A permanent visual impairment that occurs when the optic nerve is damaged
• Total blindness
• Recurrence of infection

Complications that develop from severely immunocompromised status of the individual, such as the involvement of other organs and body systems, and from other opportunistic conditions may be observed.

How is HIV Retinopathy Treated?

The treatment of HIV Retinopathy depends on the degree of signs and symptoms and severity of the condition. An early recognition and aggressive treatment is very important, often to prevent the involvement of the other unaffected eye (fellow eye). A consultation with an eye expert (ophthalmologist) who specializes in retinal disorders is frequently recommended.

Treatment for HIV infection mostly involves the following:

• Highly-active antiretroviral treatment (HAART): It is a combination of 2-3 medications and is given to treat HIV infection

• Symptomatic treatment for fever and pain to ease discomfort
• Educating the patient on the disease and its treatment

The treatment modalities for HIV Retinopathy depend on other associated conditions/infections and may include:

• Antiviral or antiparasitic medications for cytomegalovirus or toxoplasmic infections respectively
• Anti-inflammatory medications such as aspirin and steroids
• Antithrombotic therapy through the use of antiplatelet agents (such as aspirin)
• Use of local and systemic corticosteroids
• Laser photocoagulation treatment for retinal detachment
• Retinal surgery to repair extensive retinal detachments

Periodic checkups and long-term medical follow-up is warranted to minimize the risk for recurrence of HIV Retinopathy.

How can HIV Retinopathy be Prevented?

HIV Retinopathy is a common manifestation of HIV infection and is difficult to prevent.

• Early diagnosis and aggressive treatment of HIV infection and AIDS may help lower one’s risk for HIV Retinopathy
• HAART therapy has proven to be an effective treatment measure to greatly reduce one’s susceptibility to ocular involvement and complications from HIV infection
• Regular health check-ups may help individuals minimize the risk for recurrence

What is the Prognosis of HIV Retinopathy? (Outcomes/Resolutions)

HIV Retinopathy is a rapidly-progressing eye disease that develops in individuals with a severely compromised immune system against a background of HIV infection or AIDS.

• In general, the visual prognosis of the condition is grim or guarded. Without treatment, a majority of affected individuals may have total loss of vision
• The overall prognosis depends upon several factors including the severity of the underlying HIV infection and health of the individual; the outcomes vary from one individual to another

Additional and Relevant Useful Information for HIV Retinopathy:

Please visit our Eye & Vision Health Center for more physician-approved health information:

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