Question

Hi there

Thanks – yes -and any visual problems need to be seen urgently by a doctor.  If they are related to active CMV (cytomegalovirus) infection, this can cause permanent eye damage. CMV treatment is usually started the same day it is diagnosed.

The high viral load could mean that the CD4 count is very low – and being less than 50 cells/mm3 is a high risk for CMV.

There are two situations when viral load gets this high.

1. The most common case is in very early infection – perhaps after only a few weeks. This is during seroconversion and before most people even test HIV positive. In this case, the immune system usually brings viral load down again, with or without treatment. Although not common, this might mean that HIV-related infections like CMV could be causing vision problems. HIV treatment would always be started though in this case, in case someone also has a low CD4 count.
2. The other time when viral load can be several million copies/mL is in very advanced HIV infection. In this case, the CD4 count would also be damaged and low – often less the 50 cells/mm3. In this case, eye complications from CMV infection are much more common. Again, HIV treatment needs to be started if they are not already taking this, or changes to a new combination as the current ART is no longer working.

In all cases, being on effective treatment is important.

With a CD4 count that is less than 50 cells/mm3 needs very careful monitoring when starting or changing treatment in case other infections also become active. This is called IRIS and needs to be managed very carefully too.

Your second questions seems to be about whether heart problems (ie MI – myocardial infection) is a problem for people getting older with HIV.

Again, yes this is important, and it is why routine monitoring and good lifestyle options are important as we get older.