What is the main clinical presentation of CMV retinitis in patients with advanced HIV?

Cytomegalovirus (CMV) retinitis is a common opportunistic infection in patients with advanced HIV, particularly when CD4+ T-cell counts fall below 50 cells/mm³. The main clinical presentation typically includes characteristic yellow-white retinal lesions, often described as “pizza-pie” retinopathy, which are generally located around the macula.

This yellow infiltrate is indicative of the necrotizing retinitis that CMV causes, where the retina is damaged, leading to the formation of these lesions. As the condition progresses, patients may experience visual disturbances, which can include scotomas or even vision loss. The presence of these lesions is a key diagnostic feature that helps differentiate CMV retinitis from other causes of retinal disease, especially in the context of immunosuppression due to HIV.

While vitreous hemorrhage, peripheral retinal lesions, and symptoms like photophobia and eye pain can occur in various retinal conditions, they are not the hallmark presentation of CMV retinitis. Understanding the specific presentation of CMV retinitis, particularly the yellow infiltrate around the macula, is crucial for appropriate diagnosis and management in patients with compromised immune systems.