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

Rarely symptomatic (focal scotomata and decreased contrast).

Cotton-wool spots (the most common manifestation), intraretinal dot-blot and flame-shaped hemorrhages, and microaneurysms. An ischemic maculopathy may occur with significant visual loss in 3% of affected patients.

HIV retinopathy is a marker of low CD4+ counts. Look for concomitant opportunistic infections (see 12.12, Cytomegalovirus Retinitis). Rule out the other causes for unexplained cotton-wool spots (see 11.5, Cotton–Wool Spot).

No specific ocular treatment is necessary, but the retinopathy resolves with antiretroviral therapy (ART) and increased CD4+ counts.

Patients with CD4+ counts <50 cells/mm³ should be examined every 3 to 4 months.