Retinal and choroidal thickness alterations detected by optical coherence tomography in human immunodeficiency virus patients: A systematic review and meta-analysis.

Retinal and choroidal structural alterations have increasingly been recognized in individuals with human immunodeficiency virus (HIV) infection, although findings from optical coherence tomography (OCT) studies remain inconsistent. We evaluated retinal and choroidal thickness changes measured by OCT in HIV-infected individuals compared with healthy controls. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Embase from database inception to April, 2025. Studies reporting OCT-based measurements of retinal layer or choroidal thickness (CT) in HIV-infected individuals and healthy controls were included. Standardized mean differences (SMD) were pooled using fixed- or random-effects models. 21 studies involving HIV-infected individuals and healthy controls were included. HIV infection was associated with significant thinning of the macular ganglion cell-inner plexiform layer (SMD -0.55; 95% CI -0.80 to -0.29;P < 0.001), foveal inner plexiform layer (SMD -0.36; 95% CI -0.62 to -0.10;P = 0.006), temporal peripapillary retinal nerve fiber layer (pRNFL) (SMD -0.21; 95% CI -0.40 to -0.02; P = 0.03), and global pRNFL (SMD -0.20; 95% CI -0.38 to -0.02; P = 0.03). Peripheral macular ganglion cell layer (SMD 0.17; 95% CI 0.01-0.32;P = 0.034) and outer plexiform layer thickness (SMD 0.35; 95% CI 0.18-0.52;P < 0.001) were significantly increased. CT was comparable between HIV-infected individuals and healthy controls (SMD 0.15; 95% CI -0.28-0.58;P = 0.49). Overall, HIV infection appears to be associated with selective, layer-specific retinal structural alterations, predominantly affecting inner retinal layers, while CT remains largely preserved. These findings support the concept of HIV-related neuroretinal involvement and suggest that OCT-derived retinal parameters may serve as noninvasive biomarkers for detecting neurodegenerative changes in individuals with HIV infection.