HIV/AIDS and the Eye

This coming year will mark the 40^th anniversary of the first reports by the Centers for Disease Control (CDC) of the otherwise rare skin cancer Kaposi sarcoma (KS) and an equally uncommon form of pneumonia caused by the fungus Pneumocystis carinii, now called Pneumocystis jirovecii, in clusters of gay men in San Francisco and New York City.¹ Reports of other opportunistic infections caused by cytomegalovirus and Candida albicans soon followed. One year later, in 1982, Holland and colleagues² published the first series of ocular complications occurring in the setting of this incompletely understood condition in seven gay men from Los Angeles. Findings including scattered cotton-wool spots – a syndrome now termed Human Immunodeficiency Virus (HIV) retinopathy, cytomegalovirus retinitis, severe retinal periphlebitis, and conjunctival KS.^2,3 Much has transpired since those early reports,^1,4 most notably identification of the causal retrovirus - HIV - in 1984, introduction of the first nucleoside reverse transcriptase inhibitor (NRTI) in 1987, and development of triple or Highly Active AntiRetroviral Therapy (HAART) in the mid-1990. Along with these advances came a fairly complete understanding of the ocular complications of HIV and its associated Acquired ImmunoDeficiency Syndrome (AIDS)^5,6 – an understanding that subsequently required a complete reappraisal in those successfully treated with HAART who experienced relative immune reconstitution.^4,7

Such advances notwithstanding, HIV/AIDS is still an affliction of global concern. Since the beginning of the epidemic, more than 76 million people have been infected by HIV, resulting in roughly 33 million HIV-related deaths. As of the end of 2019, the World Health Organization estimated that 38.0 million people were living with HIV worldwide, including 1.8 M children. More than two-thirds, or nearly 26 million, of those infected by HIV are living in Africa.⁸ This issue of OII contains several invited reviews, presenting updates of the associated ocular surface disorders,⁹ lid and orbital involvement¹⁰ and neuro-ophthalmologic complications of HIV/AIDS.¹¹ In addition, specific HIV-associated disorders are also addressed, including syphilis^12,13 toxoplasmosis,¹⁴ tuberculosis,¹⁵ endophthalmitis¹⁶ and drug-induced uveitis.¹⁷ Current approaches to treatment are also addressed.^18,19

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.