Layer-by-layer macular, peripapillary retinal nerve fiber layer thickness and minimum rim width changes in PLWH with undetectable viral load: an OCT-based study.

purposeTo evaluate layer-by-layer macular thickness and optic nerve head parameters including the peripapillary retinal nerve fiber layer and Bruch's membrane opening minimum rim width in virologically suppressed people living with HIV and compare them with healthy controls.

methodsThis prospective cross-sectional study included 94 eyes from virologically suppressed people living with HIV and 80 eyes from age- and sex-matched healthy controls. All participants underwent spectral-domain optical coherence tomography. Layer-by-layer macular thickness, peripapillary retinal nerve fiber layer, Bruch's membrane opening minimum rim width, and subfoveal choroidal thickness parameters were analyzed.

resultsMost layer-by-layer thickness parameters in macular regions, as well as subfoveal choroidal thickness, were significantly thinner in people living with HIV than in controls (p < 0.05, for all). Also, significant thinning observed in global, temporal, and nasal inferior sectors of the peripapillary retinal nerve fiber layer and all sectors of the Bruch's membrane opening minimum rim width (p < 0.05) in people living with HIV compared to the controls. Using robust multivariable regression analyses, after adjustment for age, intraocular pressure, and axial length, HIV status remained independently associated with significantly reduced central/global retinal parameters. Correlation analysis revealed that baseline HIV RNA levels were moderately negatively correlated with the thickness of the inner temporal nerve fiber layer (r = - 0.542, p < 0.001), inner nasal nerve fiber layer (r = - 0.516, p < 0.001), central nerve fiber layer (r = - 0.553, p < 0.001) and central inner retinal layer (r = - 0.503, p < 0.001). In addition, longer disease duration was significantly associated with reduced inner plexiform layer thickness (r = - 0.351, corrected p = 0.007) and reduced inner nuclear layer thickness (r = - 0.306, corrected p = 0.035).

conclusionPeople living with HIV exhibited significant thinning in macular and peripapillary retinal layers, along with reduced subfoveal choroidal thickness compared to controls. These changes remained independently associated with HIV status after adjusting for key confounders. Higher HIV RNA levels and longer disease duration were linked to greater inner retinal thinning. Overall, the findings suggest subclinical neuroretinal involvement in HIV infection.