HIV Retinopathy

HIV Retinopathy
SYMPTOMS Typically asymptomatic but there can be Central vision loss and Peripheral vision loss in the presence of opportunistic infections such as toxoplasmosis
SIGNS Typically bilateral
Microaneurysms, Dot/blot hemorrhages, Flame hemorrhages, Roth spots, Cotton wool spots, Signs of opportunistic infections such as toxoplasmosis
WORK-UP Pupils, EOMs, Full eye exam with dilated retinal exam, OCT analysis of the macula, OCT-Angiography, Fluorescein Angiography, Fundus photos
TREATMENT Patient needs to follow up with their primary care provider in order to diagnose, evaluate, and treat HIV
Needs to be monitored closely. There is no ocular treatment
If there is the presence of opportunistic infections involving the back of the eye, patients need to be referred to a retinal specialist ASAP for treatment as well
FOLLOW-UP If there is no evidence of retinopathy, patient should be seen back in 6-12 months (depends on CD4 count and viral load)
If there is evidence of retinopathy, patient should be seen back in 3-6 months (depends on CD4 count and viral load)
Once the retina is stable following treatment by the retinal specialist, patient should be seen back every 4-6 months
ADDITIONAL LAB | TESTS The patient needs to follow-up with their PCP for additional testing if not already done which includes the following: CD4 count, Viral load, CBC with differential
ETIOLOGY Hyperviscosity and decrease in oxygen in the blood stream as well as invation of the retinal vascular endothelium by the retrovirus can cause damage to the retinal vasculature. This will lead to a decrease in retinal blood flow, oxygen, and perfusion as well as leakage
DIFFERENTIAL DX Diabetic retinopathy, Hypertensive retinopathy, Anemia retinopathy, Sickle cell retinopathy, Leukemia retinopathy
NOTES Retinopathy is seen in about 40-60% of patients who have HIV
Cotton wool spots are the most common sign seen in patients with HIV retinopathy
A lower CD4 count increases the risk of developing HIV retinopathy
Treatment with HAART greatly reduces the risk of developing HIV retinopathy
HIV Retinopathy: Fundus photo demonstrating multiple cotton wool spots in a patient with HIV retinopathy https://www.researchgate.net/figure/Several-cotton-wool-spots-typical-of-HIV-retinopathy-are-seen-in-this-photo_fig1_259957942
Posted in Ocular Conditions, Retina-Vascular