HIV and Low Vision: A Narrative Review

Human Immunodeficiency Virus (HIV) continues to be a significant global public health concern, affecting over 38 million individuals globally. Although the introduction of Highly Active Antiretroviral Therapy (HAART) has led to a significant decline in HIV-related mortality and opportunistic infections, the ocular manifestations of HIV remain a major contributor to morbidity, particularly in low-resource settings. Among the spectrum of visual complications, low vision is an under-recognized yet profoundly disabling consequence that adversely impacts quality of life, independence, and mental health. HIV-related low vision can result from multiple pathophysiological mechanisms, including direct viral damage, opportunistic infections such as cytomegalovirus (CMV) retinitis, neuro-ophthalmic complications, and HIV-associated malignancies. Clinical presentations may vary from asymptomatic retinal microvasculopathy to irreversible blindness secondary to necrotizing retinitis or optic neuropathy. The burden of ocular disease remains disproportionately high in low- and middle-income countries due to delayed diagnosis, limited access to ophthalmic care, and late initiation of antiretroviral therapy. This narrative review provides an in-depth exploration of the epidemiology, clinical spectrum, diagnostic approaches, management strategies, and rehabilitation options for low vision in the context of HIV. Special emphasis is placed on the psychosocial challenges associated with dual stigmatization from HIV and visual impairment, as well as the pressing need for integrated models of care. Emerging innovations such as portable fundus imaging, artificial intelligence-assisted diagnostics, and sustained-release ocular drug delivery systems are also discussed as part of the evolving landscape of HIV ophthalmology. Ultimately, a multidisciplinary approach-combining infectious disease management, ophthalmologic intervention, and low vision rehabilitation-is essential to address the complex needs of HIV-positive individuals at risk for or living with low vision. Early recognition and holistic care can mitigate disability, enhance functional outcomes, and improve overall quality of life in this vulnerable population.