What are HIV and AIDS?
AIDS stands for Acquired Immunodeficiency Syndrome. It is a disease of the body’s immune system, which, in a healthy person, serves to fight off illnesses and infections. It is caused by the Human Immunodeficiency Virus (HIV), which attacks many cells in the body, especially white blood cells called lymphocytes. One special kind of lymphocyte is known as the T-cell, and stages or categories of HIV infection are measured by the level of T-cells present in the body.
You may be infected with HIV and not get sick with AIDS until many years later (if ever). You are considered to have AIDS when your immune system is no longer able to keep you healthy.
It is very important to know at an early stage if you are HIV positive. If you get treatment before you are sick, you can avoid treatable side illnesses caused by HIV.
How can you become infected?
ANYONE can catch HIV. It can be spread by:
- Having unprotected sex with an infected person.
- Sharing hypodermic needles with an infected person.
- Receiving transfusions or transplants with infected blood. (Blood banks and transplant programs in the US now test blood for HIV. It is very rare to get HIV in this manner.)
- Being born by or receiving breast milk from a mother with HIV.
How does HIV/AIDS affect the eye?
There are many signs that our optometrists look for when examining the eyes of all patients:
- Cotton Wool Spots - This most common eye problem from AIDS/HIV does not threaten vision. Your eye has an inner layer called the retina, which sends images to the brain and helps us see. HIV can cause white spots in the retina, sometimes with tiny amounts of bleeding. These white spots are called “cotton wool spots” because they look like small cotton balls.
- Bacterial, Fungal, and Herpes Keratitis - Since HIV decreases the body’s protection against foreign materials, a patient is more susceptible to infections of the cornea, or the outside window of the eye. Symptoms of keratitis can include pain, light sensitivity, and blurred vision. If any of these conditions occur, please contact our optometrists immediately.
- Kaposi’s Sarcoma (KS) - KS is a kind of tumor that looks like purple-red spots. In the eyes, it can look like a bump on the eyelid or a spot on the white part of the eye. KS can look frightening, but it grows slowly and does not harm the eye.
- CMV Retinitis - A serious eye infection of the retina is caused by CMV (cytomegalovirus). About 20-30% of people with AIDS develop CMV. Most infections happen when the number of T-cells gets dangerously low. CMV can harm your vision permanently.
What are the treatments for HIV/AIDS related eye problems?
Regular eye examinations with our optometrists are required while being treated for CMV. Drugs such as Ganciclovir, Foscarnet, Cidofovir and Fomivirsen are commonly used to slow the progression of CMV infections, but they do not kill virus. If only one eye is infected, you may be able to protect the other eye by taking these anti-CMV medicines. New treatments are continuously being developed. If necessary, Kaposi’s Sarcoma can be treated with radiation, laser surgery, freezing or conventional surgery.
Cotton wool spots do not need treatment. Other eye infections due to HIV/AIDS may be treated with simple antibiotics. Each disease has its own treatment. Our optometrists are able to inform you about your specific needs.
Early diagnosis is important. The earlier our optometrists find CMV or other associated conditions, the better the odds your vision can be helped. Make sure you notify our optometrists immediately if you notice:
- Floating spots or “spiderwebs”
- Flashing lights
- Blind spots or blurred vision
These could be signs of a retinal detachment, commonly caused by CMV.
Regular eye exams are important in HIV infection.
If you have HIV, you should have a baseline examination by our optometrists. Yearly screening examinations are recommended, perhaps as often as every three to six months if your T-cell count becomes low. In those circumstances, it is more likely that you will get a serious eye infection. You should discuss these issues with our optometrists and your internist. If you experience changes in your vision, you need to see our optometrists promptly.
What about HIV in tears?
While the HIV virus can be found in tears of people with AIDS, no cases of AIDS have been reported from tear contact. Optometrists are especially careful in cleaning their lenses and instruments which come in contact with tears.