Recognising the threat of vision loss in people living with HIV on antiretroviral therapy without retinitis

Alvin J Munsamy,Rune L Brautaset,Anandan A Moodley

doi:10.4102/aveh.v79i1.547

Abstract

Background: People living with HIV (PLHIV) on antiretroviral therapy (ART) without retinitis may not have a healthy retinal structure. Aim: To examine the impact of the virus together with the ART medication in PLHIV without retinitis. Methods: This review used the following databases: PubMed, Google Scholar and EBSCOhost. Search terms included: HIV and/or retinal nerve fibre layer (RNFL); perimetry; colour vision; contrast sensitivity (CS); visual evoked potentials (VEPs); electroretinograms (ERGs); and the brain. All peer-reviewed studies related to PLHIV on ART without retinitis, up until September 2019, were included. Results: The mean RNFL thickness, and superior and inferior zones showed thinning. Affected visual functions include transient pattern VEP and ERG; contrast sensitivity; reduced total error scores on colour vision evaluation; and reduced mean deviation and pattern standard deviations on perimetry. Studies also showed concurrent thinning of the peripapillary retinal nerve fibre layer (ppRNFL) and perimetry, contrast sensitivity and colour vision. All these significant observations were seen at a cluster of differentiation 4 (CD4) count of less than 200 cells/mm 3 in PLHIV on ART with no retinitis. Further to this, studies have also related the retina to grey and white matter changes in PLHIV in the era of ART. A gap in research involves studies on the vascular impact of ART on the retina, which should be factored into studies going forward when studying PLHIV on ART. Conclusion: The decrease in visual function, the RNFL changes and neuro-ophthalmic involvement in PLHIV allow us to recognise the threat to vision loss when factoring in the expected longer lifespan that PLHIV on ART are afforded today.

Highlights

People living with HIV (PLHIV) on antiretroviral therapy (ART) without retinitis may not have a healthy retinal structure
Should we examine the impact of this virus, with its treatment of the eyes of people living with HIV (PLHIV), until such time as a vaccine is found? The ‘test and treat’ approach makes it possible to preserve the lives of PLHIV with universal access to antiretroviral therapy (ART)
It is the driving force for reduced episodes of retinitis in PLHIV by elevating cluster of differentiation 4 (CD4) counts and reducing viral loads. All of this is possible as a result of the Joint United Nations Programme on HIV/AIDS (UNAIDS) goal of 90-90-90, which suggests that this disease and its treatment cannot be separated from targeting 90% of PLHIV who are diagnosed, and who are on ART, and achieve viral suppression by 2020

Summary

Introduction

People living with HIV (PLHIV) on antiretroviral therapy (ART) without retinitis may not have a healthy retinal structure. The ‘test and treat’ approach makes it possible to preserve the lives of PLHIV with universal access to antiretroviral therapy (ART) It is the driving force for reduced episodes of retinitis in PLHIV by elevating cluster of differentiation 4 (CD4) counts and reducing viral loads. Ophthalmic clinicians need to be aware that while PLHIV on ART may not show clinical signs of eye deterioration, which usually is indicated by a lack of evidence of retinitis, as a result of the benefits of ART, this does not mean that the retinal structure is healthy. The retina may be affected by showing retinitis, in particular cytomegalovirus (CMV) retinitis All of this usually occurs when PLHIV have CD4 counts of less than 50 cells/mm[3]. This review of relevant research argues that there is evidence that ophthalmic clinicians need to adopt a proactive approach in managing the eyes of PLHIV who are on ART, until such time as a vaccine http://www.avehjournal.org

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