Leber's hereditary optic neuropathy triggered by antiretroviral therapy for human immunodeficiency virus.
OBJECTIVE
To describe the clinical features of two cases of Leber's hereditary optic neuropathy (LHON) precipitated by antiretroviral treatment for human immunodeficiency virus (HIV) infection.


METHODS
Two cases of LHON (from an expected four new cases a year throughout Australia) were identified in men on treatment for HIV infection.


RESULTS
Two HIV-infected men were receiving combination antiretroviral therapy that included nucleoside analogues. Both patients carried the 14 484 mitochondrial DNA mutation and were distantly related (seventh cousins). Although both men presented with sequential visual loss typical of LHON and one had a known close relative affected by LHON, the correct diagnosis was delayed in both cases. The final visual outcome was profoundly reduced in both instances and cessation of antiretroviral therapy did not result in recovery of vision in one patient.


CONCLUSIONS
Patients with a family history of LHON who require antiretroviral treatment should be warned of the high risk of severe visual loss. The underlying mechanism of antiretroviral side effects may help characterize the other trigger factors for LHON.
Department of Ophthalmology, Centre for Eye Research, Australia Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, Victoria 3002, Australia. D.Mackey@utas.edu.au
D A
DA
Mackey
J H
JH
Fingert
J Z
JZ
Luzhansky
P J
PJ
McCluskey
N
N
Howell
A J H
AJ
Hall
A B
AB
Pierce
J F
JF
Hoy
D019380:Anti-HIV Agents / Q000009:adverse effects*; D004272:DNA, Mitochondrial / Q000235:genetics; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D029242:Optic Atrophy, Hereditary, Leber / Q000139:chemically induced* / Q000235:genetics; D010375:Pedigree
D019380:Anti-HIV Agents; D004272:DNA, Mitochondrial