Ocular Manifestations of HIV: Unveiling the Significant Association Between High Viral Load and Reduced Intraocular Pressure in a Cohort with and without CMV Retinitis

Introduction: The relationship between Human Immunodeficiency Virus (HIV) and ocular homeostasis, particularly intraocular pressure (IOP), is complex. While decreased IOP is recognized in advanced HIV, its direct association with systemic viral replication, independent of opportunistic co-infections like cytomegalovirus retinitis (CMVR), is not fully elucidated. This study aimed to dissect this relationship by evaluating the association between HIV viral load and IOP in two distinct patient cohorts: those with and without CMVR. Methods: A comparative, cross-sectional study was conducted on 100 HIV-positive patients (50 with CMVR and 50 without CMVR) at Prof. Dr. I G.N.G. Ngoerah General Hospital from 2020–2024. Patients underwent comprehensive ophthalmological examinations, including applanation tonometry, and viral load quantification. The primary analysis evaluated the association between categorized HIV viral load (High vs. Low) and IOP (Low vs. High) using Chi-Square analysis, with odds ratios (OR) calculated to determine the strength of association. Results: A high HIV viral load was a significant predictor of decreased IOP in both cohorts. In the CMVR group, the association was strong in both the right eye (OR = 6.68; 95% CI: 1.77–25.25; p = 0.004) and the left eye (OR = 3.86; 95% CI: 1.18–12.61; p = 0.023). A similar significant association was observed in the non-CMVR group for the right eye (OR = 4.00; 95% CI: 1.14–13.99; p = 0.028) and the left eye (OR = 5.11; 95% CI: 1.50–17.38; p = 0.008). Conclusion: High systemic HIV replication is independently and significantly associated with reduced intraocular pressure, regardless of the presence of cytomegalovirus retinitis. This suggests that HIV-induced systemic inflammation and immune dysregulation directly impact aqueous humor dynamics. IOP may serve as a potential non-invasive biomarker for monitoring systemic viral control in HIV management.