Bilateral Vitreous Haemorrhage and Peripheral Neovascularisation as Part of Occlusive Noninfectious HIV Microvasculopathy – Case Report

Background

According to the report of the World Health Organization, from 37.9 million people globally living with human immunodeficiency virus (HIV), approximately two-thirds have received high active antiretroviral treatment (HAART) at the end of 2018 [1]. Nevertheless, a large majority of HIV patients still demonstrate a sight-threatening manifestation of the disease [2]. Apart from the lower number of CD4+ lymphocyte counts and higher HIV plasma viral load, nowadays, the presence of HIV retinopathy is linked to AIDS, and thus to increased mortality of HIV patients [3]. Therefore, its recognition is of importance for the management of generalised microvascular HIV disease. Not only opportunistic infectious retinochoroidal vasculitis, due to cytomegalovirus, pneumocystis carinii, syphilis, or fungal infection, but noninfectious conditions have also been linked to HIV retinopathy. Although, among the noninfectious HIV vasculopathies, mainly central and branch retinal occlusions have been reported [2], [4], up to 50% of HIV-infected individuals may show transiently appearing cotton wool spots, Roth spots, haemorrhages, capillary nonperfusion, or microaneurysms in the posterior pole, all of which are barely related to macrovasculopathy, but rather to a noninfectious microvasculopathy [5].

In the presented patientʼs case, we identified the noninfectious HIV microvasculopathy, rarely discussed so far, to be the major pathogenetic factor for presentation of bilateral peripheral retinal neovascularisation and vitreous haemorrhage.

• References

• 1 UNAIDS. Fact Sheet – Global Aids Update. Global HIV & AIDS statistics – 2019 fact sheet. Available at: http://www.unaids.org/en/resources/fact-sheet Accessed 25.09.2019
• 2 Jabs DA. Ocular manifestations of HIV infection. Trans Am Ophthalmol Soc 1995; 93: 623-683
• 3 Shah SU, Kerkar SP, Pazare AR. Evaluation of ocular manifestations and blindness in HIV/AIDS patients on HAART in a tertiary care hospital in western India. Br J Ophthalmol 2009; 93: 88-90
• 4 Dunn JP, Yamashita A, Kempen JH. et al. Retinal vascular occlusion in patients infected with human immunodeficiency virus. Retina 2005; 25: 759-766
• 5 Abu EK, Abokyi S, Obiri-Yeboah D. et al. Retinal Microvasculopathy Is Common in HIV/AIDS Patients: A Cross-Sectional Study at the Cape Coast Teaching Hospital, Ghana. J Ophthalmol 2016; 2016: 8614095
• 6 Tan S, Duan H, Xun T. et al. HIV-1 impairs human retinal pigment epithelial barrier function: possible association with the pathogenesis of HIV-associated retinopathy. Lab Invest 2014; 94: 777-787
• 7 Shah KH, Holland GN, Yu F. et al. Contrast sensitivity and color vision in HIV-infected individuals without infectious retinopathy. Am J Ophthalmol 2006; 142: 284-292
• 8 Freeman WR, Van Natta ML, Jabs D. et al. Vision function in HIV-infected individuals without retinitis: report of the Studies of Ocular Complications of AIDS Research Group. Am J Ophthalmol 2008; 145: 453-462
• 9 Kozak I, Sasik R, Freeman WR. et al. A degenerative retinal process in HIV-associated non-infectious retinopathy. PLoS One 2013; 8: e74712