CMV Retinitis: Gateway to Blindness in HIV Patients

July 17, 2016 | Pulitzer Center

Aditi Kantipuly

The HIV epidemic disproportionately affects injection drug users and is a major public health concern in many countries worldwide. In India, the prevalence of HIV injection in drug users is highly concentrated in the northeastern region, because of the proximity to the Golden Triangle—the world’s major point of illicit drug production. Pictured above are injection drug users in Madurai, Tamil Nadu. Image by Aditi Kantipuly. India, 2016.

Patients at the government antiretroviral (ART) Center, Chennai, Tamil Nadu. Image by Aditi Kantipuly. India, 2016.

Opportunistic infections in relation to HIV affect vulnerable populations to a greater extent but this is not always the case. An HIV-positive patient affected with CMV retinitis identified as a priest (not shown above, as he did not want to be photographed). The priest from Chennai, Tamil Nadu, says he contracted HIV from a blood transfusion during a prior heart surgery. Image by Aditi Kantipuly. India, 2016.

Dr. Jeetesh Singh, interacts with an HIV patient at Doctors Without Borders site in Manipur (northeastern India). Singh, a general physician, was one of the first doctors at the site to receive specialized training, in 2015, so as to allow for earlier diagnosis of CMV retinitis and other infections with retinal manifestations. Singh believes that this new program will help "reduce vision loss among HIV-positive individuals being initiated on antiretroviral therapy." Image by Aditi Kantipuly. India, 2016.

India's HIV epidemic has "pockets" or certain areas where vulnerable groups have a much higher prevalence of HIV, such as the case with injection drug users in Manipur in northeast India. As pictured in this demo here, the materials needed for a "high" are minimal. Image by Aditi Kantipuly. India, 2016.

An HIV-positive transgendered patient (left), diagnosed with CMV retinitis, was not able to afford the cost of treatment, and she has now become blind. Image by Aditi Kantipuly. India, 2016.

Sex workers are often a vehicle for transmission of HIV. The Marina Beach in Chennai is a hotspot for sex work at night. The beach, separated into unmarked boundaries, dividing transgendered, female, and male sex workers, has been revolutionized with mobile technology. Clients can now negotiate their rates, meeting places, and times instantly through mobile phones, making sex work more difficult to monitor by law enforcement. Prostitution is illegal in India. Image by Aditi Kantipuly. India, 2016.

The Koyambedu Bus Terminal is also a considered a hotspot for sex work. Pictured above, a transgendered sex worker interacts with a potential client. The terminal currently caters to over 250,000 passengers a day. Image by Aditi Kantipuly. India, 2016.

Dr. Sridharan Sudharshan, a leading eye specialist at Sankar Nethralaya, interacts with a HIV-positive woman diagnosed with CMV retinitis and her son. This family has traveled over 175 kilometers to be seen at this private hospital. According to the son, his mother contracted HIV from his father, who committed suicide when he found he was HIV-positive. In fear that his mother would also commit suicide, the son decided to withhold her HIV-positive status from her. Image by Aditi Kantipuly. India, 2016.

Globally, 3 million HIV patients have experienced ocular complications. Yet, a reference to CMV retinitis, or CMVR, an opportunistic infection responsible for more than 90 percent of cases of AIDS-related blindness, is absent from the World Health Organization’s guidelines on HIV/AIDS. Russia, China, and Thailand have all recently promoted the use of eye exams, leading to the early detection and treatment of CMVR as well as tuberculosis, a leading cause of mortality in HIV patients. An eye exam may prevent the tragedy of blindness and mortality, and it will also serve as a report card to monitor our success or failure in the AIDS epidemic. This slideshow looks at patients with CMVR in India.