Patients who have been infected with the HIV virus are at risk of developing numerous complications systemically as well as in the eye. Since the introduction of new medical therapies in the late 90’s for the systemic treatment of the HIV infection, the number of ocular complications has dropped dramatically. However, patients with HIV infections remain at high risk of developing ocular complications. These complications can be broken down into two classes: those related to opportunistic infections and those thought to be related to the HIV infection itself. The simple presence of the HIV virus can lead to the development of ocular problems which are grouped together and known as HIV retinopathy.
HIV retinopathy refers to a group of findings which are made clinically by your eye specialist. Most commonly, HIV retinopathy does not have significant signs or symptoms associated with it. Accordingly, many patients who have HIV retinopathy may not know that they are experiencing ocular complications. The presence of HIV retinopathy can be seen in up to 50% of patients who have low CD 4 counts. This is a non-infectious complication of HIV infection which must be distinguished from those opportunistic infections which can invade or compromise the retina in patients who have AIDS. The typical findings of HIV retinopathy include retinal infarcts, hemorrhages, and even microaneurysms. This triad of clinical findings can also be seen in patients who have other systemic diseases not related to HIV, including hypertension, diabetes, and radiation retinopathy. Accordingly, the importance of patients informing their physician that they have been infected with the HIV virus is important when trying to make an appropriate diagnosis. The underlying etiology, or cause, for HIV retinopathy is not currently known. However, it is thought to be an immune mediated process in the retina which leads to the deposition of immune complexes in the vascular endothelium thereby causing alterations in the blood flow patterns throughout the retina that may ultimately lead to the development of these micro infarcts or intraretinal hemorrhages. There are many similarities between those undergoing the basic disease process and those who have other problems of their microvasculature, like those associated with diabetes.