To investigate relationships between contrast sensitivity (CS), color vision, and retinal nerve fiber layer (RNFL) among people with human immunodeficiency virus (HIV) infection; to evaluate the effect of time since diagnosis of HIV infection on RNFL thickness.

Noninterventional cross-sectional study.

We evaluated 102 eyes of 57 HIV-infected individuals without ocular opportunistic infections. Peripapillary RNFL thickness was determined with spectral-domain optical coherence tomography in 4 quadrants. CS was measured with the Pelli-Robson technique (expressed as logCS); color vision was measured with the Lanthony desaturated 15-hue technique (expressed as color confusion index [C-index], with higher scores indicating worse color vision). Correlations between values were assessed using Spearman correlation coefficients.

Median RNFL thickness (average of 4 quadrants) was 102.9 μm (range, 75.0–134.7 μm). Median logCS was 1.90 (range, 1.25–1.95). Median C-index was 1.58 (range, 0.96–4.07). Temporal RNFL thickness was correlated with logCS (r = 0.295, P = .003) and C-index (r = −0.338, P = .0005). Time since diagnosis of HIV infection was shorter for those with thick average RNFL than for those with thin average RNFL (P = .18).

Both worse CS and worse color vision are correlated with thinning of the temporal RNFL, with possible threshold effects. Increased prevalences of abnormal CS and abnormal color vision in this population are therefore likely attributable to neuroretinal compromise. This pattern of structural and functional losses may reflect preferential damage to small-caliber axons in the maculopapillary bundle, possibly associated with mitochondrial dysfunction, providing a potential disease mechanism for HIV-associated “neuroretinal disorder.”