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Early HIV Visual Changes (Revised)
Mar 28, 2001

Dr. Feinberg, Thank you for posting my viewpoint a few weeks ago. I have since done more research and have subsequently revised my hypothesis.

OBSERVATION: A large percentage of recently infected HIV patients develop cobweb-type floaters.

PROBABLE CAUSE: Collagen Type II (also called cartilage collagen) is found in joints, eyes, & the inner ear. This collagen is probably affected by the inflammatory response to HIV. Expert research documents the following: There is evidence of cross-link formation of vitreous collagen during experimental ocular inflammation. Separate documentation records that mutations in Collagen Type II can cause abnormalities of the skeleton and eye.

HYPOTHESIS: There is a link between HIV infection and the formation of dense collagen fibers within the vitreous humor.

ASSOCIATED CASE: Initial HIV symptoms occurred approx. 14 days post exposure. On-set included genital ulcers, truncal rash, night sweats, nausea, and painful lymphnoids. Resolution of initial symptoms occurred approximately 2 weeks later followed by a 4-month duration of migratory myalgias and arthralgia. As muscle and joint pains resided, developed sudden on-set of cobweb-like floaters in both eyes. Ohthalmologists unable to determine specific cause; eyes noted as otherwise healthy.

QUESTION: Have you observed HIV patients with these cobweb-like floaters? Any other comments on this issue are greatly appreciated.

DISCLAIMER: Floaters are usually nonspecific developments and can be a common part of the aging process.

Response from Dr. Feinberg

I have not seen acutely or recently-infected individuals who have complained about floaters. In general, I don't think it's accurate to say that floaters are common in early HIV infection. I have not seen floaters listed as a typical symptom of early HIV infection in articles or textbooks about HIV. Floaters mean that there is debris in the eye, and usually this is due to inflammation but can also be due to aging. I don't know enough about different collagen fibers and their behavior to support or refute your revised hypothesis.

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