HAART induced retinal complications in HIV patients

S Sudharshan

Purpose: Highly active antiretroviral therapy (HAART) has drastically reduced occurrence of opportunistic infections in patients with HIV disease. Although, HAART can cause systemic side effects, Ocular side effects are not very common. We report a case series of patients with drug related retinal complications after initiation of HAART

Methods: All patients initiated on HAART and with complaints of decrease in vision attributable to drug related side effects were included. All other causes of possible vision loss such as opportunistic infections were ruled out.

Results: 5 patients were included. Case 1, 2, 3 came with complaints of colour vision and night vision defects post-HAART. ERG findings were suggestive of diminished or extinguished rod or cone response or an altered response. HAART regimen was modified and the retinal changes reversed to normal in 2 patients both objectively and subjectively. In one patient, there was no reversal until 3 month follow-up. Case 1, 4, 5 developed central serous retinopathy(CSR) and multiple PEDs which resolved with changed HAART regimen. Case 1 was treated with Laser therapy for Multifocal recurrent CSR. There was no recurrence until 6 month follow-up.

Conclusions: Although HAART improves general health of patients with HIV and prevents ocular complications such as opportunistic infections, they may cause retinal toxicity. These include colour vision and night vision defects as shown in ERG and CSR like response. Early identification and appropriate change in the drug regimen may help reverse such blinding complications and restore vision.