Purpose: To determine the prevalence of cytomegalovirus retinitis (CMVR) and other fundus lesions in subjects with acquired immunodeficiency syndrome (AIDS) before and after the introduction of highly active antiretroviral therapy (HAART) in China. Methods: The retrospective study included subjects with AIDS who consecutively attended a third referral center in Beijing before and after HAART was introduced. Comprehensive systemic and ophthalmic examinations, including CD4+ T-cell count, ophthalmoscopy, and fundus photography, were carried out. Results: A total of 173 HIV-infected, HAART-naive individuals and 267 people undergoing HAART were included in the study. The HAART-naive group as compared with the HAART group was significantly older (39.5 +/- 11.5 years versus 36.7 +/- 11.2 years; p = 0.02) and included significantly more men (p = 0.045). Prevalence of CMVR, microvascular retinopathy, and optic neuropathy in the HAART group (9.0 +/- 1.8%, 7.9 +/- 1.7%, and 4.9 +/- 1.3%, respectively) were significantly (all p <= 0.001) lower than in the HAART-naive group (20.2 +/- 3.1%, 31.2 +/- 3.5%, and 13.9 +/- 2.6%, respectively). Microvascular retinopathy was significantly associated with HAART-naive status (p < 0.001; odds ratio [OR] 0.20; 95% confidence interval [CI] 0.12, 0.36) and higher age (p = 0.002; OR 1.04; 95% CI 1.10, 1.06). Cytomegalovirus retinitis was significantly associated with CD4+ cell count < 50 cells/mu L (p = 0.001; OR 5.50; 95% CI 1.95, 15.5), HAART-naive status (p = 0.02; OR 0.23; 95% CI 0.07, 0.79), and lower best-corrected visual acuity (p < 0.001; OR 5.44; 95% CI 2.11, 14.0). Conclusions: As in Western countries, prevalence of CMVR and microvascular retinopathy in Chinese subjects with AIDS were significantly associated with a low CD4+ cell count and a HAART-naive status as the 2 major risk factors.