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Jihen BROUR, Christine FARDEAU, Brigitte BEGO, Phuc LEHOANG; Long Term Follow Up Of Antiretroviral Macular Toxicity. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5197.
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To describe the occurrence and the long term follow up of antiretroviral induced maculopathy in six human immunodeficiency virus-positive (HIV+) patients.
In this retrospective monocentric study, six HIV+ patients receiving at least two nucleotide reverse transcriptase inhibitors (NRTIs) and presenting a presumed toxic maculopathy were followed up between 1992 and 2009. Patients with a familial retinopathy or taking known toxic medications for macula were excluded. Monitoring of visual acuity, fundus examination, automatic perimetry, electrophysiology, fluorescein angiography and optical coherence tomography was carried out.
Mean age of the patients was 38+/-8 years with a sex ratio of 5/1. At the moment of the diagnosis, three patients were receiving 2 NRTIs + 1 protease inhibitor, two were taking only 2 NRTIs and one patient had 2 NRTIs + 1 Non NRTIs. Duration of therapy before presentation was 5,2 years. No argument for HIV retinopathy or opportunist infection was found. Initial visual acuity ranged from 20/20 to 20/400 with a median of 20/50. All patients had bilateral and symmetric perifoveal depigmentation (unless one monophtalm patient). Fluorescein angiography revealed annular hyperfluorescence in the macular region compatible with a transmission defect at the level of the RPE. Optical coherence tomography showed macular atrophy in 5 eyes of 3 patients and small serous retinal detachment in 3 eyes of 2 patients. Multifocal electroretinograms realized for 3 patients showed bilateral significant abnormalities in the foveal amplitude.We noted stabilization of visual function and angiographic findings when NRTIs were discontinued and deterioration when reintroduced in three patients.
Symmetric lesions and chronologic evolution of our patients’ maculopathy highly suggest toxicity of antiretroviral drugs (NRTIs). Clinicians should keep in mind this diagnosis in HIV+ treated patients before irreversible macular atrophy stages occur.
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