HIV Retinitis

1. Epidemiology
   1. Most common HIV ocular complication
2. Etiologies
   1. Most Common Retinitis Etiology
      1. Cytomegalovirus Chorioretinitis
   2. Other causes
      1. Varicella Zoster Virus
      2. Pneumocystis carinii
      3. Toxoplasma gondii
3. 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
4. Symptoms
   1. Vision changes (usually unilateral)
      1. Painless blurred vision
      2. Floaters in visual field
      3. Light Flashes
      4. Scotoma
5. 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
6. 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
7. Complications
   1. Retinal Detachment with sudden loss of vision
8. Monitoring
   1. Ophthalmology exam every 6 months (CD4 Count <100/mm3)
   2. Ophthalmology exam every 3 months (CD4 Count <50/mm3)
9. Management
   1. Treat Retinitis immediately to prevent blindness
   2. See Cytomegalovirus for treatment