Illustration of a child's eye with a mosaic retina, representing HIV and vision.

HIV and Children's Vision: What Parents Need to Know

Theo Raines in Health & Wellness July 2025 • 4 min read.

"New research sheds light on potential vision changes in HIV-infected children, emphasizing the importance of regular eye exams."

In the early days of the HIV epidemic, severe eye infections like CMV retinitis were a common and devastating complication. Thanks to advancements in combination antiretroviral therapy (CART), these infections are now far less frequent. However, researchers are discovering that even with effective treatment, HIV can still have subtle effects on the eyes, leading to what's being called "HIV-associated neuroretinal disorder" (HIV-NRD).

While much of the research on HIV-NRD has focused on adults, a recent study investigated whether similar changes occur in children who have been infected with HIV since birth and are receiving CART. This study aimed to uncover any differences in the structure and function of the retina – the light-sensitive tissue at the back of the eye – between HIV-infected children and their healthy peers.

The findings offer important insights for parents and caregivers of HIV-infected children, highlighting the need for proactive eye care to ensure their children's vision remains clear and healthy.

What the Study Revealed: Subtle Changes in Retinal Thickness

Illustration of a child's eye with a mosaic retina, representing HIV and vision.

The study, published in Investigative Ophthalmology & Visual Science, compared 33 HIV-infected children on CART to 36 healthy children. The groups were carefully matched for age, sex, ethnicity, and socioeconomic status to ensure a fair comparison. All participants underwent comprehensive eye exams, including tests of visual function and optical coherence tomography (OCT), a sophisticated imaging technique that measures the thickness of different layers of the retina.

The results showed that HIV-infected children had a statistically significant decrease in total foveal thickness, particularly the outer nuclear layer and inner segments (ONL-IS) within the fovea. The fovea is the central part of the retina responsible for sharp, detailed vision. This thinning was associated with higher peak HIV viral loads in the past, suggesting a possible link between the virus and retinal changes.

Contrast Sensitivity: The HIV-infected group showed slightly lower contrast sensitivity, meaning they had more difficulty distinguishing between shades of gray.
Retinal Nerve Fiber Layer (RNFL): No significant differences were found in the thickness of the RNFL, which is often affected in adults with HIV-NRD.
Color Vision and Visual Fields: No significant differences were detected in color vision or central visual field tests between the two groups.

It’s important to note that the observed changes were subtle, and all participants had normal visual acuity. However, the findings suggest that HIV may be affecting the development or maintenance of the fovea in children, potentially impacting their long-term vision.

What This Means for Parents and Future Research

While this study sheds light on potential retinal changes in HIV-infected children, more research is needed to understand the long-term implications of these findings. Longitudinal studies that follow children over time will help determine whether these subtle changes progress, stabilize, or even reverse. In the meantime, the study underscores the importance of regular, comprehensive eye exams for all HIV-infected children, even those receiving effective treatment. Early detection of any vision problems can allow for timely intervention and help ensure a lifetime of healthy vision.

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Everything You Need To Know

What is HIV-associated neuroretinal disorder (HIV-NRD), and how does it relate to HIV-infected children?

HIV-associated neuroretinal disorder (HIV-NRD) is a condition where HIV, even with effective combination antiretroviral therapy (CART), can subtly affect the eyes. While much of the research has focused on adults, the focus here is on children, specifically those infected with HIV since birth and receiving CART. The study indicates potential changes in the retina, particularly in the fovea, which might impact their long-term vision. The research compares HIV-infected children on CART to healthy peers to determine if there are differences in retinal structure and function, highlighting the need for proactive eye care for these children.

What specific eye tests were conducted on the children in the study, and what were the key findings?

The study used comprehensive eye exams, including tests of visual function and optical coherence tomography (OCT). OCT is a sophisticated imaging technique that measures the thickness of different layers of the retina. The primary finding was a statistically significant decrease in total foveal thickness in HIV-infected children, specifically in the outer nuclear layer and inner segments (ONL-IS) within the fovea. The HIV-infected group also showed slightly lower contrast sensitivity. No significant differences were found in the Retinal Nerve Fiber Layer (RNFL), color vision, or central visual field tests.

How does CART impact the eye health of HIV-infected children, and why are regular eye exams still important?

Combination antiretroviral therapy (CART) has significantly reduced severe eye infections like CMV retinitis, a common complication in the early days of the HIV epidemic. However, even with CART, HIV can still cause subtle changes, leading to conditions like HIV-NRD. Regular, comprehensive eye exams are still crucial because the study revealed potential retinal changes, especially impacting the fovea, which is responsible for sharp vision. Early detection allows timely intervention to maintain healthy vision.

What are the potential implications of the study's findings regarding retinal changes in HIV-infected children?

The study's findings suggest that HIV may affect the development or maintenance of the fovea in children. The observed thinning of the fovea, particularly the ONL-IS, could potentially impact their long-term vision. Although all participants had normal visual acuity, these subtle changes warrant attention. The study also suggests a link between the virus and retinal changes, as the thinning was associated with higher peak HIV viral loads in the past. These findings underscore the need for ongoing monitoring through regular eye exams.

What further research is needed to understand the long-term impact of HIV on the vision of children, and what can parents do in the meantime?

More research is needed to understand the long-term implications of the observed retinal changes. Longitudinal studies, following children over time, will help determine whether the subtle changes progress, stabilize, or reverse. In the meantime, parents and caregivers of HIV-infected children should ensure regular, comprehensive eye exams. Early detection of any vision problems can allow for timely intervention. Proactive eye care is essential for ensuring children maintain clear and healthy vision throughout their lives.