Abstract
PURPOSE: To report a 35-year-old man with human immunodeficiency virus (HIV) and bilateral progressive decrease in vision thought to be caused by HIV optic neuropathy but associated with a severe attenuation of the electroretinogram. METHODS: Case report, review of laboratory studies, visual fields, and electroretinogram. RESULTS: Visual function deteriorated in an asymmetric fashion over 9 months of follow-up and continued to deteriorate, even when the patient had no detectable viral load. No evidence of cytomegalovirus retinitis or HIV retinopathy was present. An electroretinogram showed severe attenuation of both rod and cone-mediated functions. CONCLUSIONS: In addition to producing retinal ganglion cell axonal degeneration, HIV may also damage the other retinal elements. The progression of visual loss in the absence of detectable virus has implications for the pathogenesis and prognosis of HIV-associated vision loss.
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