Purpose:
To describe the occurrence and the long term follow up of antiretroviral induced maculopathy in six human immunodeficiency virus-positive (HIV+) patients.
Methods:
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.
Results:
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.
Conclusions:
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.
Keywords: drug toxicity/drug effects • retinal pigment epithelium • AIDS/HIV