HIV Disease: Cotton Wool Spots
These microinfarcts of the retina, which occur in many diseases, are common findings even in the early stages of HIV disease.
They reflect antigen-antibody plugs rather than infection, although cytomegalovirus retinitis, a finding in advanced HIV disease, starts with cotton wool spots. They do not interfere with vision.
What to do?
Cotton wool spots are a marker for HIV disease. If the patient has very low CD4 counts, beware that the cotton wool spots are a precursor of cytomegalovirus retinitis. The patient must be reexamined within days to verify lack of progression.