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Assessment of Retinal and Choroidal Microvascular Alterations in HIV-Positive Individuals Using Optical Coherence
Vikas Ambiya1, Srishti Khullar1, Sharan H B1
1Department of Ophthalmology, Armed Forces Medical College, Pune, India.
Purpose:
To evaluate retinal and choroidal microvascular changes in HIV-positive individuals using optical coherence tomography angiography (OCTA), and to assess their correlation with CD4 T-cell count.
Methods:
In this cross-sectional study, 50 HIV-positive individuals on stable antiretroviral therapy and 50 age- and sex-matched healthy controls underwent macular OCTA imaging. Vessel density (VD) and vessel length density (VLD) were quantified across multiple retinal and choroidal layers. CD4 counts were recorded and participants were stratified into low ( < 350 cells/mm3) and normal (≥350 cells/mm3) CD4 groups.
Results:
HIV-positive individuals showed significantly reduced VD in the superficial vascular plexus (SVP) compared to controls (30.95 ± 8.64% versus 34.98 ± 4.70%; p < 0.01), and significantly higher choroidal VLD (8.77 ± 0.75 mm/mm2 versus 8.01 ± 1.69 mm/mm2; p < 0.01). Although not statistically significant, a trend toward reduced VD and VLD was noted across other retinal layers. The superficial foveal avascular zone (FAZ) area was marginally larger in the HIV group (p = 0.08). Among HIV-positive participants, those with CD4 < 350 had lower SVP VD and significantly higher choroidal VLD than those with CD4 ≥ 350 (p = 0.067 and p = 0.032, respectively).
Conclusion:
OCTA reveals subclinical retinal and choroidal microvascular alterations in HIV-positive individuals, particularly in those with lower CD4 counts. Reduced SVP VD and increased choroidal VLD may reflect early vascular dysfunction, supporting the use of CD4 count as a biomarker for ocular microvascular health in HIV.
