Bull's Eye Maculopathy in an HIV-Positive Patient Receiving Ritonavir

Non, Lemuel; Jeroudi, Abdallah; Smith, Bradley T.; Parsaei, Shadi

doi:10.3851/imp3007

Cited by 8 publications

(10 citation statements)

References 6 publications

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“…A review of the world literature disclosed 11 cases of ritonavir maculopathy reported between 2011 and 2019, to which we add our present case (patient 1). Results are compiled in Table 1 (1,(4)(5)(6)(7)(8)(9)(10)(11). All reported patients were male, the only female being our patient.…”

Section: Discussionmentioning

confidence: 94%

“…We searched the world literature for similar cases through PubMed and Google Scholar, using the terms "HIV, " "AIDS, " "ritonavir, " "didanosine, " "maculopathy, " "retinopathy, " "visual loss, " and "toxicity." Our literature search disclosed nine publications of retinal toxicity due to ritonavir between 2011 and 2020, for a total of 11 cases (1,(4)(5)(6)(7)(8)(9)(10)(11). Details are provided in Table 1.…”

Section: Review Of the Literaturementioning

confidence: 99%

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Case Report: Multimodal Imaging of Toxic Retinopathies Related to Human Immunodeficiency Virus Antiretroviral Therapies: Maculopathy vs. Peripheral Retinopathy. Report of Two Cases and Review of the Literature

Hammer

Borruat

2021

Front. Neurol.

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Purpose: We report two patients with toxic retinopathy from either ritonavir or didanosine and reviewed the literature on the topics. We provide an overview of the retinal toxicity of these two antiretroviral drugs in human immunodeficiency virus-positive patients.Methods: First, we performed a retrospective study of the medical charts of two patients examined by us, one with ritonavir maculopathy and one with didanosine peripheral retinopathy. Secondly, we searched the world literature for similar cases through PubMed and Google Scholar, using the terms “HIV,” “AIDS,” “ritonavir,” “didanosine,” “maculopathy,” “retinopathy,” “visual loss,” and “toxicity” to retrieve the appropriate literature on the subject.Results: Patient 1: A 49-year-old woman complained of progressive central visual loss over the past 12 months. History disclosed ongoing ritonavir therapy for the past 11 years. Ritonavir maculopathy was diagnosed, and visual loss increased relentlessly despite cessation of treatment. Patient 2: A 55-year-old man complained of slowly progressive peripheral visual field constriction for the past 5 years. History disclosed didanosine therapy for 13 years, however, stopped 4 years before the onset of visual symptoms. No alteration of therapy was offered to patient 2 as didanosine therapy was interrupted 9 years previously. Since 2011, 11 cases of ritonavir maculopathy have been reported in the literature. Relentless worsening of vision was reported in 3/7 patients despite cessation of ritonavir therapy. Didonasine peripheral retinopathy was first described in 1992, and a total of 24 patients have been reported since. Relentlessly progressive peripheral retinopathy was diagnosed despite the previous cessation of therapy in 14 patients.Conclusion: Ritonavir causes a slowly progressive atrophic maculopathy, and didanosine toxicity results in a relentlessly progressing peripheral atrophic retinopathy. The relentless progression of both toxic retinopathies reflects permanent alterations of the retinal metabolism by these medications. Both ritonavir and didanosine toxic retinopathies are rare events, but their clinical presentation is highly specific.

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Section: Discussionmentioning

confidence: 94%

Section: Review Of the Literaturementioning

confidence: 99%

Case Report: Multimodal Imaging of Toxic Retinopathies Related to Human Immunodeficiency Virus Antiretroviral Therapies: Maculopathy vs. Peripheral Retinopathy. Report of Two Cases and Review of the Literature

Hammer

Borruat

2021

Front. Neurol.

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“…In the last few years, several case reports of pigmentary maculopathy, often in a Bull's-eye-like pattern, associated with ritonavir (a protease inhibitor) or efavirenz (a non-NRTI) use, have been reported [24][25][26][27][28][29]. These patients presented early with reduced vision due to the macular pathology [24][25][26][27][28][29]. Ritonavir toxicity is thought to be dose-related and related to phospholipidosis with crystalline deposits seen at the macula [25,26,29].…”

Section: Other Haart Retinal Toxicitymentioning

confidence: 99%

“…These patients presented early with reduced vision due to the macular pathology [24][25][26][27][28][29]. Ritonavir toxicity is thought to be dose-related and related to phospholipidosis with crystalline deposits seen at the macula [25,26,29]. The pathophysiology of efavirenzrelated toxicity remains unclear.…”

Section: Other Haart Retinal Toxicitymentioning

confidence: 99%

Didanosine-Associated Retinal Toxicity (DART) Amongst HIV-Positive Patients: a Case Series and Literature Review

Nderitu

Riga

Mann

et al. 2020

SN Compr. Clin. Med.

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The aim of this study is to report on didanosine-associated retinal toxicity (DART) in four adult patients with human immunodeficiency virus (HIV) identified incidentally during routine diabetic eye screening and review all reported cases to date. This study is a retrospective, observational, case series from two health institutions with a review of published literature. DART is often asymptomatic, and patients have good vision (mean visual acuity 6/9), but in advanced cases, severe visual field defects can occur. Fundal changes range from mild granular pigmentary mottling to patches of mid-peripheral chorioretinal atrophy. Continuous expansion of chorioretinal degenerative changes posteriorly may lead to significant macular involvement as demonstrated in two of our cases. Despite cessation of therapy, DART was progressive in approximately 25% of reported cases. Our cases were incidentally discovered during routine diabetic eye screening and did not report any ocular symptoms prior to referral. Given the initial asymptomatic nature of DART, we believe that the true prevalence of the disease may be higher than previously thought. It may be prudent to screen and follow-up patients with a history of DDI use. We demonstrate the utility of multimodal imaging, optical coherence tomography, electrodiagnostic testing and visual fields in evaluating the effects of DART.

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“…The case report titled “Bull's eye maculopathy in an HIV-positive patient receiving ritonavir” by Non et al [ 37 ] was excluded for the lack of sufficient clinical details and imaging.…”

mentioning

confidence: 99%

Possible Retinal Impairment Secondary to Ritonavir Use in SARS-CoV-2 Patients: A Narrative Systematic Review

Cozzupoli

Savastano

Falsini

et al. 2020

Journal of Ophthalmology

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Some reports described a possible ritonavir-related retinal toxicity. The objective of this research was to review and analyze previous studies conducted on ritonavir administration and retinal impairment in a narrative synthesis. PubMed was used to perform a systematic review of ritonavir effects and retinal damage. All studies up to December 2019 were considered. Seven single cases and one case series, reporting a total of 10 patients affected by retinal changes secondary to long-term ritonavir treatment, were included in the review. Variable degrees of outer retina and retinal pigment epithelium changes were detected in most of the patients, with two patients showing macular telangiectasia, four patients presenting intraretinal crystal deposits, two patients disclosing a bull’s eye maculopathy, and two patients revealing midperipheral bone spicule-like pigment changes. In the present study, we hypothesized that the use of ritonavir in life-saving treatments of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pneumonia might expose these patients to the risk of developing a retinotoxicity. We aimed to alert ophthalmologists on the importance of recognizing ritonavir-induced retinal impairment in SARS-CoV-2 patients. These findings are the target for personalized medicine.

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Bull's Eye Maculopathy in an HIV-Positive Patient Receiving Ritonavir

Cited by 8 publications

References 6 publications

Case Report: Multimodal Imaging of Toxic Retinopathies Related to Human Immunodeficiency Virus Antiretroviral Therapies: Maculopathy vs. Peripheral Retinopathy. Report of Two Cases and Review of the Literature

Case Report: Multimodal Imaging of Toxic Retinopathies Related to Human Immunodeficiency Virus Antiretroviral Therapies: Maculopathy vs. Peripheral Retinopathy. Report of Two Cases and Review of the Literature

Didanosine-Associated Retinal Toxicity (DART) Amongst HIV-Positive Patients: a Case Series and Literature Review

Possible Retinal Impairment Secondary to Ritonavir Use in SARS-CoV-2 Patients: A Narrative Systematic Review

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