AIDS and ophthalmology: a contemporary view

The appearance of the Acquired Immune Deficiency Syndrome (AIDS) meant a revolution in medicine, which has also affected Ophthalmology: the routine presence of ophthalmological pathologies which until then had been exceptional, such as retinitis due to cytomegalovirus (CMV), and the appearance of other new pathologies such as progressive outer retinal necrosis (PORN). The generalised use of high activity antiretroviral therapy (HAART) in the second half of the 1990s represented a turning point, since when the immunological improvement of patients with Human Immunodeficiency Virus (HIV) resulted in a fall in the cases with ophthalmological pathology associated to immunodepression (HIV retinopathy, retinitis due to CMV, PORN...), and the spontaneous improvement of symptoms which until then had had a torpid evolution (Kaposi's ocular sarcoma, Palpebral Molluscum...). On the other hand, the continuous increase in the prevalence of syphilis in these patients means an increase in the number of cases of ocular syphilis unassociated with immunodepression. New ophthalmological alterations also appear that are related to HAART: uveitis due to immune recovery in patients with CMV retinitis in complete remission and the enophthalmos due to the atrophy of orbital fat in the context of lipodystrophy, associated with antiretrovirals. At present preventive ophthalmological checks must be carried out on patients with severe immunodepression until a count of lymphocytes above 100 cells/microl is confirmed. If they also show HIV retinopathy, a monthly check up is advisable until immune recovery, given the greater risk of infection by CMV.