Since the 1980s, those living with HIV and AIDS have been dealing with devastating physical and emotional side effects. Untreated, HIV advances to AIDS. This highly infectious disease wreaks havoc on the immune system, affecting vital organs and deteriorating overall health. While some of you may know that AIDS can damage the lungs and digestive tract, how many of you know about the impact HIV and AIDS can have on the eyes?
Your eyes are one of the most complex and sensitive organs. When infected with HIV, they can become a gateway for opportunistic infections that may lead to vision impairment or permanent blindness. In this article, we will explore the complex relationship between HIV, AIDS, and ocular health. We will also delve into the history and link between HIV and ophthalmology, as well as discuss the eye diseases associated with late-stage HIV infection.
HIV Origin, Incidence, and Mortality
As its complete medical term suggests, the human immunodeficiency virus (HIV) is a pathogen targeting people’s disease-fighting immune systems. Everyone infected becomes susceptible to various illnesses, as their immune system continues to weaken. Having multiple sexual partners, engaging in unprotected intercourse with an HIV-positive person, getting tattooed with a previously used needle, and receiving injections through contaminated syringes are the leading causes of HIV transmission.
Living with HIV is a lifelong sentence. As mentioned, if left undetected and untreated, HIV may lead to AIDS or acquired immunodeficiency syndrome. AIDS can severely compromise the immune system, making the infected person even more vulnerable to diseases.
Originating in Central Africa, the World Health Organization declared HIV a global epidemic in 1981. However, according to researchers, the viral infection may have jumped to humans from chimpanzees as far back as the 1800s.
In 2021, 38.4 million people were living with HIV worldwide. Although AIDS-related deaths have decreased by 68% since peaking in 2004, around 650,000 people (adults and children) still died from the virus and its complications that same year.
Introduction of Antiretroviral Therapy for HIV and AIDS
In the 1960s, medical researcher Jerome P. Horwitz synthesized a compound called zidovudine (AZT), which he hoped would help treat cancer. Although he failed to deliver the drug’s intended purpose, Dr. Horwitz’s discovery revolutionized the way doctors treat HIV and AIDS instead.
In 1987, the Food and Drug Administration approved AZT (under the brand name Retrovir) as the very first anti-HIV (antiretroviral) drug.
While antiretroviral therapy helps prevent HIV from reproducing and slows the destruction of the immune system, it is not a cure. Unfortunately, long-term HIV infection can disrupt multiple body parts, including the eyes.
Link Between HIV and Eye Health
A year after proclaiming HIV a global endemic, doctors began noticing eye problems among infected patients. In 1996, a 10-year study examined 3257 HIV/AIDS patients. Among them, 723 chosen to undergo an eye exam exhibited at least one of the following eye-related issues:
- Microvasculopathy: Appearance of cotton wool spots and hemorrhages in the eyes.
- Molluscum contagiosum: Consists of one or multiple fluid-filled pimples along the eyelids or surrounding skin.
- Kaposi’s sarcoma: Cancerous purple patches or nodules on the conjunctiva and eyelids.
- Cerebral toxoplasmosis: An opportunistic, parasitic infection inhibiting eye movements. Over time, it can cause a cerebral abscess or pus-filled pockets of infected material in the brain.
- Cytomegalovirus: A herpesvirus that may cause neurological damage in individuals with compromised immune systems.
More recently, a review updated in 2022 confirmed some of the latter conclusions and revealed additional ocular manifestations of HIV. According to co-authors Feroze and Wang, HIV may lead to the following ocular conditions, causing possible vision loss by affecting the eye’s posterior segment involvement (includes the retina, choroid, and optic nerve):
- Retinal microangiopathy
- Cytomegalovirus retinitis
- Varicella-Zoster (VZV) retinitis
- Toxoplasma retinochoroiditis
- Bacterial and fungal retinitis
Patients may also complain about light flashes, floaters, reduced visual acuity, and visual field defects.
Below, we will dive deeper into the most prevalent HIV-related eye diseases in the United States.
Common HIV-Associated Eye Diseases and Infections
HIV weakens the immune system, making patients vulnerable to the following eye diseases that prey on bodies with compromised defenses.
1. Cytomegalovirus Retinitis
“Cotton wool spots” or CMV retinitis is the most common HIV-related eye disease in the United States. This herpes-type virus can lead to obstructed vision or even permanent blindness among people with AIDS.
CMV retinitis is an AIDS-defining disease. However, researchers have observed non-HIV cases of CMV in immunocompromised individuals, such as those undergoing treatment for an autoimmune disorder, hematologic cancer, bone marrow or organ transplant, and following local steroid administration. Due to its rarity, the precise incidence rates of CMV retinitis HIV-negative patients are unknown.
Its primary ophthalmoscopic features include white textured zones of retinal necrosis (lesions) with or without bleeding and low-grade iritis and vitritis (intraocular swelling and irritation).
Treatment for CMV retinitis involves antiviral drugs that target the cytomegalovirus. The most common prescription medications are ganciclovir, valganciclovir, and foscarnet. Patients can take these orally, through injections, or implantable devices. These medications can help delay or stop the progression of CMV and prevent further damage to the retina.
2. Herpes Simplex Virus (HSV) Keratitis
HSV is a virus that can cause painful fever blisters or cold sores on the lips and mouth. In some cases, it can also infect the cornea – the transparent layer of tissue at the front of the eye. HSV keratitis can trigger eye redness, pain, and blurred vision. In severe cases, the virus can cause corneal scarring and blindness.
Some treatments can reduce the severity and recurrence of symptoms, but there is no cure for HSV.
HIV-positive individuals are more prone to bacterial and viral infections, including conjunctivitis, which is the inflammation of the conjunctiva – the thin layer of tissue covering the white part of the eye. Conjunctivitis can cause temporary redness, itching, and discharge in one or both eyes.
4. Optic Neuritis
Optic neuritis causes inflammation of the optic nerve, which is responsible for transmitting visual information or messages from the eye to the brain. It can cause pain, changes in color perception, and sudden vision loss. The condition often resolves within four to 12 weeks without treatment. In severe or chronic cases, such as in HIV patients, intravenous corticosteroids may be necessary to speed recovery.
5. Kaposi’s Sarcoma
Kaposi’s sarcoma is a rare form of cancer. It can cause painless purplish spots on the eyelids, conjunctiva, or whites of the eye. Vision problems leading to blindness are possible complications without treatment.
It’s important to note that AIDS-defining diseases are serious health conditions requiring prompt treatment. If you have HIV or AIDS and have noticed changes in your vision, seek an ophthalmologist in Sun City, AZ, preferably a seasoned professional well-versed in examining and diagnosing HIV-related eye diseases. If you need an eye doctor near you, contact us to schedule a private consultation.