Risk factors for ocular complications in HIV/AIDS patients: a retrospective analysis of ophthalmology consultations in a tertiary hospital in Central China

Acquired immunodeficiency syndrome (AIDS) affects 39.9 million people worldwide. Despite antiretroviral therapy, sight-threatening ocular complications, such as cytomegalovirus retinitis (CMVR), remain common, yet contemporary incidence data from Asian populations are scarce. To quantify the incidence of fundus lesions and identify independent predictors of ocular lesions among HIV-positive inpatients referred for ophthalmologic evaluation at a tertiary center in Central China. All consecutive HIV-1-positive inpatients aged ≥ 18 years who underwent standardized ophthalmic screening from 19 November 2019 to 9 June 2023 were included. Data on demographic, systemic, and ocular characteristics were collected. Binary logistic regression models were used to identify factors associated with fundus lesions. Of 345 eligible individuals, 117 had fundus lesions, classified into three main types. The distribution was 35.9% for opportunistic infections, 59.8% for HIV-related microangiopathy, and 4.3% for syphilis-related uveitis. The opportunistic infections group was common among the youngest age group [median age: 41.5 years, IQR: 32–54 years], with 38.1% reporting blurred vision. Patients in the microangiopathy group had the lowest CD4+ T cell count [median count: 18.5 cells/µL, IQR: 5–40.25 cells/µL] and the shortest duration of HIV/AIDS [median month: 0.7 months, IQR: 0–6.5 months]. The syphilis-related uveitis group had the longest duration of HIV/AIDS [median month: 24 months, IQR: 8.125–54 months], the highest CD4+ T cell count [median count: 166 cells/µL, IQR: 41–224.5 cells/µL], and the most frequent complaint of blurred vision (80%). In this contemporary Central-Chinese cohort, CMVR remains the leading ocular sequela despite widespread HAART. Age, nadir CD4+ < 50 cells/µL, and symptomatic visual loss are independent red flags. We propose routine dilated fundus examinations every 3 months for patients with any of these predictors and immediate ophthalmic referral at the onset of visual symptoms.