Case Report: Retinal Toxicity Secondary to Ritonavir

Area of Science:

• Ophthalmology
• Pharmacology
• Infectious Diseases

Background:

• Increased life expectancy in HIV patients due to antiretroviral therapy can lead to iatrogenic complications.
• Drug toxicity, such as ritonavir-induced retinal toxicity, is an emerging concern in HIV management.
• Ritonavir retinal toxicity is infrequently reported, necessitating further case documentation.

Observation:

• A 53-year-old male HIV patient presented with nyctalopia and blurred vision.
• Ophthalmic examination revealed bilateral maculopathy with midperipheral bone spicule-like pigmentary changes.
• Optical coherence tomography (OCT) demonstrated ellipsoid zone abnormalities and hyperreflectivity.

Findings:

• The patient exhibited annular retinal pigment epithelium mottling and midperipheral bone spicules.
• OCT revealed subfoveal ellipsoid zone hyperreflectivity, parafoveal loss, and eccentric punctate hyperreflectivity.
• Fundus autofluorescence showed parafoveal and midperipheral hyperautofluorescence patterns.

Implications:

• This case underscores ritonavir as a potential cause of retinal toxicity, leading to visual impairment.
• The described OCT findings contribute to understanding the pathognomonic features of ritonavir retinopathy.
• Increased awareness of this adverse event is crucial for early diagnosis and management in HIV patients.