Optical coherence tomography angiography measurements in patients with HIV: a systematic review and meta-analysis

To evaluate the evidence for alterations of blood flow, vascular and perfusion densities in the macula, and peripapillary region in patients with Human Immunodeficiency Virus (HIV) based on changes of OCTA parameters.

A systematic review of PubMed, Scopus, WOS, and Embase databases, including quality assessment of published studies, investigating the alterations of OCTA parameters in HIV patients was conducted. The outcomes of interest comprised changes of perfusion and Vascular Densities (VD) in Superficial and Deep capillary plexus (SCP and DCP), Foveal Avascular Zone (FAZ) area, and Retinal Nerve Fiber Layer (RNFL).

From the total of 322 articles obtained from the databases, the meta-analysis included six studies, including 270 patients with HIV and 275 healthy controls for SCP and DCP vascular densities, as well as 216 cases and 214 controls for RNFL thickness. The aggregated investigation revealed markedly lower foveal SCP (Hedge's g: -0.45; 95% CI [-0.86 to -0.04], p = 0.03) and DCP (Hedges' g: -0.31; 95% CI [-0.50 to -0.24], p < 0.001) vascular densities, as well as diminished temporal (Hedges' g: -0.97; 95% CI [-1.48 to -0.46], p < 0.001) and nasal parafoveal SCP (Hedges' g: -0.74; 95% CI [-1.14 to -0.35], p < 0.001) and DCP ( (Hedges' g: -0.40; 95% CI [-0.76 to -0.04], p = 0.03) and (Hedges' g: -0.29; 95% CI [-0.60 to 0.02], p = 0.07)) vascular densities in HIV-positive patients compared to healthy controls. No significant differences were observed in parafoveal nasal, superior, or inferior vascular densities at the DCP and SCP levels, nor in RNFL thickness between the two groups. The FAZ extent at SCP showed no significant changes in HIV-positive patients. The findings highlight retinal microvascular alterations in HIV patients, particularly in specific regions of the fovea and parafovea.

In this systematic review and meta-analysis, our goal was to examine the changes in the retinal vasculature in HIV patients and assess how well OCTA, an advanced diagnostic technique, works to identify these alterations. Our findings suggest significant reductions in parameters such as foveal SCP and DCP VD, as well as temporal and nasal parafoveal SCP and DCP VD in HIV patients compared to healthy controls. While these changes offer valuable insights into HIV-associated retinal microvasculopathy, their utility as potential diagnostic biomarkers requires further validation.