Analysis of macular microvasculature changes in human immunodeficiency virus infection using swept-source OCT angiography

To evaluate macular optical coherence tomography angiography (OCTA) parameters and microvascular alterations in Human Immunodeficiency Virus (HIV)-positive patients, with and without clinically detectable HIV-related non-infectious retinal vasculopathy. This comparative study included HIV-positive patients and age- and sex-matched healthy controls. All participants underwent multimodal retinal imaging, including color fundus photography, fluorescein angiography, and macular OCTA. Quantitative OCTA parameters—parafoveal vessel density (VD) of the superficial (SCP-VD) and deep capillary plexuses (DCP-VD), as well as foveal avascular zone (FAZ) area, perimeter, and circularity—were analyzed. Qualitative microvascular changes were also assessed. A total of 102 HIV-positive patients and 100 healthy controls were included. All six eyes with clinically detectable HIV retinopathy demonstrated perifoveal capillary abnormalities on OCTA. Among HIV-positive eyes without funduscopic or angiographic evidence of retinopathy, 72 eyes (75%) showed microvascular changes on en face OCTA. Mean SCP-VD and DCP-VD were significantly reduced in the HIV group compared to controls (p < 0.001 and p = 0.004, respectively). FAZ was significantly larger and less circular in HIV-positive eyes (p < 0.001). Multivariate analysis revealed that longer duration of HIV infection correlated significantly with OCTA vascular changes (p = 0.033). OCTA enables early detection of subclinical retinal microvascular alterations in HIV-positive patients, even in the absence of clinically apparent retinopathy.