How HIV affects the eyes of aging adults

A recent study led by researchers from the University of Colorado Anschutz Department of Ophthalmology has found that older adults with well-controlled HIV may have a higher prevalence of certain eye conditions compared to their similarly aged counterparts without HIV. The study, published in the journal Viruses, is the first of its kind to comprehensively examine eye health in adults aged 60 and above who have durably suppressed HIV, which means the person's viral load is low and they cannot transmit HIV to others.

Lead author Alison Abraham, Ph.D., MS, MHS, a professor in the Department of Epidemiology at the Colorado School of Public Health, emphasizes the importance of vision as a primary sense that many people rely on. Age-related vision issues can significantly impact an individual's quality of life, and those aging with HIV may face a higher burden of chronic conditions, some of which may manifest at younger ages than in people without HIV.

The research, known as the HIV Vision Study, compared 74 older adults living with HIV with 65 adults without HIV. The findings revealed that 15% of people with HIV had uncorrected refractive error, compared to 5% of those without HIV. Additionally, about half of the participants with HIV were diagnosed with cataracts or had undergone cataract surgery, in contrast to 20% of individuals without HIV. Vision-threatening eye diseases like macular degeneration and diabetic retinopathy were rare in both groups.

Abraham was surprised to discover that dry eye disease was more prevalent in both groups. Around 63% of people living with HIV and 51% of those without HIV exhibited clinical signs of dry eye disease, with moderate-to-severe tear insufficiency being almost identical between the groups (34% versus 33%). However, the study noted that meibomian gland dysfunction was significantly more common in HIV-positive individuals (20% versus 8%).

While the exact cause of this increased prevalence of dry eye disease remains unknown, Abraham suspects that persistent immune activation and inflammation associated with chronic HIV infection could play a role. Despite HIV being a noninfectious disease, it can still affect ocular tissues. The study highlights the need for further research to understand the mechanisms behind this observation and potential implications for managing eye health in older adults with HIV.