Posterior segment manifestations of human immunodeficiency virus/acquired immune deficiency syndrome

Abstract

Ocular manifestations can occur in up to 50% of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients and posterior segment involvement is the most common presentation. The posterior segment manifestations of AIDS can be divided into four categories: retinal vasculopathy, opportunistic infections, unusual malignancies and neuro-ophthalmologic abnormalities. Retinal microvasculopathy and cytomegalovirus (CMV) retinitis are the most common manifestations, even in the era of highly active anti-retroviral therapy (HAART). Highly active anti-retroviral therapy has been shown to cause regression of CMV retinitis, reduce the incidence of CMV-related retinal detachments, and prolong patient survival. Immune recovery uveitis is a new cause of vision loss in patients on HAART. Diagnosis and treatment are guided by the particular conditions and immune status of the patient.

Figure 1

Microvasculopathy

Figure 2A

(A) Classic CMV retinitis: pizza-pie appearance

Figure 2B

(B) Granular variety of CMV retinitis

Figure 2C

(C) Frosted-branch angiitis variety of CMV retinitis

Figure 3

Acute retinal necrosis

Figure 4

Progressive outer retinal necrosis

Figure 5

Toxoplasmic retinochoroiditis

Figure 6

Pneumocystic choroiditis

Figure 7

Cryptococcus involvement of optic nerve and retina

Figure 8

Multiple choroidal tubercles due to ocular tuberculosis

Figure 9

Solitary mass lesion due to ocular tuberculosis

Figure 10

Severe vitritis due to immune recovery uveitis