Value of Fundus Examination in Screening for HIV Infection

Abstract

Retinal microangiopathy is one of the known manifestations of HIV infection, sometimes misleading as it closely resembles that observed in diabetic or hypertensive retinopathy. It reflects a systemic microangiopathy for which the retina offers a true window into the microcirculation. It may reveal a previously unknown infection or allow for evolutionary monitoring. We report two observations where the discovery of signs of retinal microangiopathy led to the diagnosis of HIV seropositivity. The first case is that of a 34-year-old man, with no history of arterial hypertension, diabetes, or known seropositivity, presenting with left ocular redness corresponding to a temporal and inferior subconjunctival hemorrhage. Fundus examination revealed a few rare cotton-wool spots, microaneurysms, and punctate hemorrhages at the posterior pole. Blood pressure and blood glucose were normal, and HIV serology was positive. The patient, referred for specialized consultation, was lost to follow-up. The second case concerns a 26-year-old woman, with no particular history, referred for a stage 2 pterygium of the right eye. Systematic fundus examination revealed a few cotton-wool spots at the posterior pole, without retinal hemorrhage. Blood pressure and blood glucose were normal, HIV serology was positive. She was also lost to follow-up. These observations highlight the importance of fundus examination as a tool for early screening. Any unexplained retinal microangiopathy, particularly in young subjects without cardiovascular risk factors, should prompt investigation for HIV infection. Keywords: Fundus examination; Retinal hemorrhage; Retinal microangiopathy; Cotton-wool spot; HIV.