Viral Infections USMLE Step 1 Practice Question

A 45-year-old man with HIV infection presents to the emergency department with a 2-week history of progressive visual loss, floaters, and photopsia in his right eye. He denies eye pain or photophobia. He has not been on antiretroviral therapy. On examination, vital signs are stable. Dilated funduscopic examination reveals multiple intraretinal hemorrhages and granular infiltrates along the distribution of blood vessels in the peripheral retina with a granular, hemorrhagic appearance. The anterior chamber is quiet with no signs of uveitis. Laboratory studies show a CD4+ count of 32 cells/μL and HIV RNA level of 850,000 copies/mL. Which of the following is the most likely diagnosis?