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Symptoms ⬇

Rarely symptomatic (focal scotomata and decreased contrast).

Signs ⬆ ⬇

Cotton–wool spots, intraretinal hemorrhages, and microaneurysms. An ischemic maculopathy may occur with significant visual loss in 3% of affected patients.

Work Up ⬆ ⬇

Workup

HIV retinopathy is a marker of low CD4+ counts. Look for concomitant opportunistic infections (see 12.9, CYTOMEGALOVIRUS RETINITIS). Rule out the other causes for unexplained cotton–wool spots (see 11.5, COTTON–WOOL SPOT).

Treatment ⬆ ⬇

No specific ocular treatment is necessary, but the retinopathy resolves with cART and increased CD4+ counts.

Follow Up ⬆

Patients with CD4+ counts <50 should be examined every 3 to 4 months.

Noninfectious retinopathy is the most common ocular manifestation of HIV/AIDS. About 50% to 70% of patients with AIDS have this condition.