Ophthalmologic Aspects of HIV Infection

The ocular manifestations are often seen in patients with acquired immunodeficiency syndrome (AIDS). Such conditions are generally classified into five areas. This includes a non-infectious microangiopathy, most often seen in the retina and sometimes called "AIDS retinopathy." Second is opportunistic ocular infection, particularly cytomegalovirus (CMV) retinitis. Third is conjunctival, eyelid, or orbital involvement by those neoplasms seen in patients with AIDS. Fourth being neuroophthalmic lesions and finally, drug-induced manifestations. Retinal microangiopathy is the most frequent ocular manifestation and CMV retinitis is the most frequent opportunistic intraocular infection. Recent advances in the treatment of human immunodeficiency virus (HIV) infection, specifically the development of highly active antiretroviral therapy (HAART), have altered the frequency and management of opportunistic ocular infections. Furthermore, ophthalmoscopic features of HIV retinopathy include cotton wool spots, intraretinal hemorrhages, and less frequently, perivascular sheathing. Cotton wool spots are microinfarcts of the nerve fiber layer of the retina caused by ischemic disruption of axonal transport. Axonal swelling produces characteristic white, opaque lesions.