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HIV RetinitisAka: CMV Chorioretinitis, CMV Retinitis

Epidemiology
1. Most common HIV ocular complication
Etiologies
1. Most Common Retinitis Etiology
  1. Cytomegalovirus Chorioretinitis
2. Other causes
Risks
1. CD4 Count < 100
  1. Confers 20% CMV retinitis risk in 2 years
  2. Usually occurs when CD4 Count < 50
2. Invasive Cytomegalovirus confers 90% retinitis risk
Symptoms
1. Vision changes (usually unilateral)
  1. Painless blurred vision
  2. Floaters in visual field
  3. Light Flashes
  4. Scotoma
Signs: Focal Necrotizing Retinitis
1. Retinal hemorrhage, exudation, edema
2. Opaque lesions with patchy hemorrhage and Vasculitis
3. Ischemic retinopathy
  1. Cotton wool spots (areas of ischemic infarction)
  2. Usually no hemorrhage or edema
Course
1. Disease progresses rapidly
  1. Irreversible blindness in 2 weeks if not treated
2. Recurrence of CMV retinitis
  1. Inevitable despite treatment (foscarnet, ganciclovir)
  2. Median 3-4 months (days-weeks without treatment)
  3. Ganciclovir implants may delay for 7 months
Complications
1. Retinal Detachment with sudden loss of vision
Monitoring
1. Ophthalmology exam every 6 months (CD4 Count <100/mm3)
2. Ophthalmology exam every 3 months (CD4 Count <50/mm3)
Management
1. Treat Retinitis immediately to prevent blindness
2. See Cytomegalovirus for treatment

Cytomegalovirus Retinitis (C0206178)
Definition (MSH)	Infection of the retina by cytomegalovirus characterized by retinal necrosis, hemorrhage, vessel sheathing, and retinal edema. Cytomegalovirus retinitis is a major opportunistic infection in AIDS patients and can cause blindness.
Definition (CSP)	opportunistic retinal herpes viral infection in AIDS.
Concepts	Disease or Syndrome (T047)
English	CMV retinitis, Cytomegaloviral Retinitis, Cytomegalovirus Retinitis
Spanish	retinitis citomegaloviral, retinitis CMV
Credits	Derived from the NIH UMLS (Unified Medical Language System)