HIV - Ocular abnormalities - Late clinical manifestations

Keratitis can be caused by various organisms ranging from herpes viruses to microsporidia.

Minor infarctions in the retinal nerve layer (“cotton-wool spots”) are very frequent. They are transient and are of no further significance. In Europe before the era of antiviral combination therapy approximately 20% of AIDS patients developed ocular lesions due to infection with the cytomegalovirus. CMV retinitis is rare in developing countries as most patients do not survive a very severe immunodeficiency condition for a sufficiently long period of time (they die earlier of something else). CMV spreads from cell to cell in the retina and causes a peripheral or paracentral scotoma (retinal necrosis) that gradually becomes larger. Tunnel vision is one consequence of the destruction of the peripheral retina. Multiple minor haemorrhages and perivascular sheathing is characteristic of this infection. Retinal detachment can follow focal atrophy of the retina. If left untreated it can lead to blindness. Blindness is caused less frequently (3%) by toxoplasmosis retinitis. In cases of toxoplasmosis of the retina there is also a high risk (30%) of toxoplasmosis of the brain. Pneumocystis carinii choroiditis is very rare. Retinal necrosis can be caused by herpes simplex or herpes zoster virus.