Ocular manifestations seen in HIV

There were an estimated 34 million people living with human immunodeficiency virus (HIV) infections at the end of 2011 globally, with 2.5 million new infections in 2011. The later stages of HIV infection, termed clinically as acquired immunodeficiency syndrome (AIDS), are defined as CD4þ T-lymphocytes being profoundly diminished (o200 cells/μL), or as opportunistic infections or neoplasms having developed. It is at this later stage when ocular manifestations are most commonly seen. Overall, 50–70% of patients with HIV eventually develop ocular manifestations, with postmortem studies showing rates of ocular findings closer to 90%. The most common ocular manifestations of AIDS are CMV retinitis and retinal microvasculopathy; however, there are many other complications that can cause loss of vision. Highly active antiretroviral therapy (HAART), introduced in 1996, changed the observed ocular presentation of AIDS. HAART uses a combination of antiretroviral drugs to decrease HIV replication, and a recovery of CD4þ helper T-cell population is typical, resulting in fewer opportunistic infections, improved quality of life, and reduced morbidity and mortality. This has been reflected with the occurrence rates of CMV retinitis and other HIV/AIDS-associated ocular infections decreasing by 50% or more. Even with these vast improvements, ocular complications continue to occur and cause disability among patients with HIV/AIDS. Increases in the prevalence of less severe, chronic problems, have been brought about by these drug combinations allowing patients to live longer with lower levels of immune capacity. The following is a discussion of commonly seen ocular manifestations of HIV/AIDS in the United States in the post-HAART era.