Analysis of Retinochoroidal Vasculature in Human Immunodeficiency Virus Infection Using Spectral-Domain OCT Angiography

Purpose: To describe the retinochoroidal vascular alterations in patients with human immunodeficiency virus (HIV) infection using en face OCT angiography (OCTA). Design: Cross-sectional study. Participants: Twenty-six patients with HIV infection (5 women, with and without HIV retinopathy) were included in the study. Nineteen healthy participants (7 women) with no known ocular disease were recruited as healthy controls. Methods: Multimodal imaging was performed using OCTA (Optovue RTVue XR Avanti; Optovue, Inc, Fre- mont, CA), enhanced-depth imaging OCT (Heidelberg Spectralis; Heidelberg Engineering, Heidelberg, Germany), color fundus photography, and fluorescein angiography (FA). Vessel flow density (VFD) was calculated auto- matically by the OCTA software. Morphologic changes in the retinochoroidal vasculature in the posterior pole on OCTA were assessed by 2 trained independent graders and were compared with the findings on clinical ex- amination and other imaging techniques. Main Outcome Measures: Prevalence of microvascular alterations on OCTA among patients with HIV and differences in the VFD in different macular sectors compared with healthy controls. Results: Among all eyes with clinically detectable HIV retinopathy, there was evidence of retinal vascular telangiectasia, capillary loops, and increased intercapillary spacing. The mean VFD values were lower among patients with HIV retinopathy compared with those with HIV and no retinopathy and healthy controls (both P < 0.05). Foveal avascular zone area was abnormally enlarged among patients with HIV compared with healthy controls (P 1⁄4 0.05). Five eyes (23.53%) without clinical or angiographic evidence of retinopathy demonstrated retinal vascular telangiectasia and increased intercapillary spacing on OCTA. The inner choroidal vasculature appeared to be mostly unaffected in HIV. Conclusions: OCT angiography provides noninvasive high-resolution imaging of the retinochoroidal vascular network in patients with HIV. Compared with conventional imaging, OCTA can demonstrate precise microvas- cular structural alterations in the retinal vessels and seems to be a sensitive tool in detecting HIV retinopathy.