Human immunodeficiency virus (HIV) weakens an individual’s immune system when it destroys CD4 or T-cells that fight infections and diseases in the body. To date, there is no known cure for HIV. Individuals get infected with the virus through risky sexual behavior and sharing intravenous needles with those who are HIV positive. Children are likely to get infected when born or breastfed to a mother with the HIV virus. However, due to advancements in the medical field, HIV positive mothers can now deliver HIV negative children, not to mention breastfeed safely without transmitting the virus to the child.
An individual has acquired immunodeficiency disease (AIDS) when opportunistic diseases take advantage of a weakened immunity. With proper medical care, however, the disease can be managed.
HIV is present in the tears of people with the disease. However, there is no evidence that tears can cause HIV when they enter the body of a healthy person.
Since HIV involves a breakdown of the immune system, it can infect any part of the body (including the eye). HIV positive individuals in good health may not have eye problems related to the disease. However, those with advanced AIDS are likely to develop eye diseases. These eye problems may affect the inside of the eye and around it too.
HIV/AIDS of the eye is manifested in the following diseases/conditions:
- HIV retinopathy – It is the most popular among individuals living with AIDS. The HIV causes cotton-wool spots and blood from broken blood vessels on the retina.
- CMV retinitis – Cytomegalovirus (CMV) occurs in those with a very low T-cell count. It affects approximately 20 - 30 % of individuals living with AIDS.
- Detached retina – A detached retina can result from CMV. The retina detaches from its normal position at the back of the eye. It is a severe problem that needs urgent treatment. Without treatment, a detached retina can lead to severe vision loss.
- Kaposi sarcoma – Rare cancer in people living with AIDS.
- Squamous cell carcinoma of the conjunctiva – It is a tumor involving the conjunctiva related to HIV/AIDS. The disease is also associated with human papillomavirus (HPV) infection and excessive exposure to sunlight.
- Eye infections – Those with HIV may get the following diseases which can threaten vision: gonorrhea, toxoplasmosis, microsporidia, syphilis, dry eye, chlamydia, pneumocystis, herpes virus and candida.
- Herpes zoster ophthalmicus (HZO) - A common infection caused by a reactivation of the chickenpox virus. The disease is popular with older individuals above 60 years and younger ones with HIV. HZO may cause loss of vision.
Causes and Risk Factors
Eye problems related to HIV/AIDS occur because of the infection. HIV/AIDS can affect anyone regardless of sex, race and age.
Signs & Symptoms
The signs and symptoms of eye problems related to HIV/AIDS may vary according to the particular ailment. For example, symptoms for CMV include inflammation of the retina, bleeding and loss of vision. CMV is a serious disease that needs prompt treatment because it can lead to severe loss of vision within a few months. Other vision-threatening symptoms of CMV that require immediate medical attention include:
- Blind spots or blurry vision
- Seeing ‘spider-webs’ or floating spots
- Flashing lights
For Kaposi sarcoma, the following symptoms may be present:
- A purple-red lesion that forms on the eyelids or white part of the eye
- A red, fleshy lesion develops on the conjunctiva
General symptoms for HIV-related eye diseases may include:
- Teary eyes
- Pain in the eye
- Sensitivity to light
- Double or blurry vision
- Changes in color vision
- Growth on the eye
- Floaters – Spots moving in the field of vision
People living with HIV should have a comprehensive quarterly eye examination. Frequent examinations can help to diagnose serious ailments like CMV to prevent loss of vision. Examinations may include a slit-lamp examination, visual acuity test, imaging and so on.
Treatment for eye problems caused by HIV/AIDS is directed towards treating the particular disease causing it.
Medical treatment of HIV/AIDS eye related problems depends on the underlying cause. For example, CMV retinitis has no cure. However, certain medications can slow the progression of the virus. Also, medicines can help treat certain infections in other diseases.
Patients are advised to keep the immune system healthy with antiviral drugs to reduce the risk of
HIV-related eye diseases.
A detached retina surgery can save a patient’s vision in almost all cases of retinal detachment. The surgeon will restore the retina to its original position.
Tumors can also be treated with surgery or radiation.
Complications and prognosis depend on the various types of diseases associated with HIV/AIDS. For example, Kaposi sarcoma does not harm the eye and is treatable. The lesions, however, may have a frightening appearance.
People living with HIV/AIDS must go for a routine eye examination, preferably every three months. This action helps in the early detection of problems for prompt treatment.
Protection against HIV is the best protection against HIV-related eye problems. Protection against HIV may include:
- Using condoms during sex
- Abstaining from sexual activity
- Getting tested for HIV and sexually transmitted diseases
- Not injecting oneself with drugs
- Using pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) in case one intends to have or has had unprotected sex
- Preventing mother-to-child transmission