Eye sign

[Swat_valley]

I had prophylactic eye laser for lattice degeneration and retinal holes in my right retina. Diagnoses was by a staff grade opthalmologist. Laser was performed by the senior consultant . There was no mention of any cotton wool spot in either eye by them. After 2 weeks, I had a follow up and was seen by another doctor. She thought (but not certain) there was a cotton wool spot in right retina (lasered eye). She said hypertension, Diabetes, infection, vasculitis etc. could cause such lesion. Anyways, I searhed on net and found HIV can cause cotton wool spot(s). The next day of eye examination, I had an HIV1 and 2 antibodies test and Thanks God, it was negative. Test was done by a GP using Insti (TM) rapid test, which is recognised in about 40 countries, including Canada and European Union.

She arranged a followup which was I think after 12-14 days. This time I was seen by the Staff grade opthalmologist (not her) who had initially diagnosed my lattice degeneration and retinal holes. He examined and said that he specifically focused on the area documented by the other doctor but he could not see any cotton wool spot. He said not to worry.

I was so relaxed until I read about a case report where a lady had cotton wool spots in HIV seroconversion illness, but she also had other features such as diarrhoea (main symptom). I could find only one case report. Most information suggests that such ocular signs is more common in advanced HIV, mainly with low CD4. However people in early HIV infection can have it (they did not say seroconversion illness, but early infection). My risks included ALWAYS protected intercourse with CSWs and unprotected oral both ways. Last one was probably 21 days prior to her concern about possible cotton wool spot

I am so worried about HIV now. My FBC,renal profile, diabetes check, BP, CRP and ESR were normal. Do you think such eye finding was possibly a feature of HIV seroconversion? I am planning further test at 6 months.

Thanks a lot.

[Edward W Hook, MD]

I still see no reason for testing.  EWH

[Swat_valley]

One last question/comment. As you noted, she (the opthalmologist) did see 'something' as she took some reyinal pics and showed me that spot. Even next day, when I went to an optician, the spot was there on retinal images also taken at opticians' store. But the optician did not look worried about it. Anyways, that spot was not seen by other opthalmologist who specifically looked for it in further follow up after 10-14 days.

I got worried as I read HIV can cause transient cotton wool spot(s). As my last exposure before this questionable spot finding was about 21 days ago ( protected intercourse and unprotected oral both ways) and in ALL previous 3 months prior to this ocular finding, I had similar such exposures on few occassions.

That is why I became so worried about HIV as the sexual contacts were with sex workers (escorts).

Will you still advise no further HIV testing. This is last question.

Thanks

[Swat_valley]

Thanks for the answer.

As you said cotton wool spot was always questionable, as she said it could be drusen, could be cotton wool spot, could be chorio-retinitis.

She did take retinal pics and showed me the spot. But ofcourse in follow-up the images were available in my case notes. I was worried because I read that in HIV these spots could be transient.

Well to be honest, I was relaxed after negative HIV test until I searched on net HIV seroconversion and cotton wool spot and found that it could happen in seroconversion illness. And ofcourse I got worried due to sex with CSWs (protected intercourse and unprotected oral both ways).

Thanks a lot for your guidance, much appreciated.

[Edward W Hook, MD]

Is it possible?- yes.  Is it likely - no, no more likely than your being hit by lightening in the next 24 hours.  

For starters, you do not know if you have cotton wool spots.  Odds are that you do not since the POSSIBLE cotton wool spot was seen by only 1 of the 3 people who examined you, including the expert who was specifically looking for them.

Second, cotton wool spots, as your reading has already told you, are non-specific findings which are not at all uncommon and, when they appear, are very, very non-specific, having been related to a number of different illnesses.

Finally, and most importantly, you have a negative HIV test.  Believe the test.

thus to summarize, you really don’t even know if you have a cotton wool spot and if you do, it is a non-specific finding; you do not have HIV.  In my judgment the there is no medical reason for you to seek further testing.  EWH