Retinal pigment epitheliopathy, macular telangiectasis, and intraretinal crystal deposits in HIV-positive patients receiving ritonavir.
OBJECTIVE
The purpose of this study was to describe the occurrence of a retinal pigment epitheliopathy associated with macular telangiectasis and intraretinal crystal deposits in three human immunodeficiency virus-positive patients receiving long-term ritonavir as part of highly active antiretroviral therapy.


METHODS
The patient's records were reviewed.


RESULTS
The CD4 T-cell counts at presentation were 163 cells per microliter, 464 cells per microliter, and 349 cells per microliter, and viral loads were undetectable in all patients. None of the patients had a concurrent AIDS-defining illness. Other significant medical history included hyperlipidemia in one patient and a remote history of lymphoma and tuberculosis in a second patient. Initial visual acuity ranged from 20/32 to 20/400, with a median of 20/150. Anterior segment examination and intraocular pressures were normal in all eyes. Posterior segment examination revealed bilateral macular retinal pigment epitheliopathy with intraretinal crystalline deposits. No hemorrhage or cotton wool spots were seen consistent with human immunodeficiency virus retinopathy, and there was no evidence of previous or active cystomegalovirus retinitis. Fluorescein angiography revealed parafoveal telangiectasis with late leakage in two of the three patients. Optical coherence tomography showed thickening of the macula in three eyes and inner foveal cysts in two eyes. Autofluorescence performed on one patient revealed complete loss of normal retinal pigment epithelium autofluorescence corresponding to the area of retinal pigment epitheliopathy bilaterally. The only medicine common to all 3 patients was ritonavir, and the duration of ritonavir therapy before presentation was 19 months in one patient, 30 months in the second patient, and 5 years in the third patient.


CONCLUSIONS
Retinal changes characterized by retinal pigment epitheliopathy, parafoveal telangiectasias, and intraretinal crystal deposits occurred in three human immunodeficiency virus-positive patients on long-term ritonavir as part of highly active antiretroviral therapy.
Roe
Richard H
RH
Retina-Vitreous Associates, Los Angeles, California, USA. roe.rick@gmail.com
Jumper
J Michael
JM
Gualino
Vincent
V
Wender
Jon
J
McDonald
H Richard
HR
Johnson
Robert N
RN
Fu
Arthur D
AD
Cunningham
Emmett T
ET
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005451:Fluorescein Angiography; D015745:Granuloma, Foreign-Body / Q000175:diagnosis / Q000209:etiology*; D017320:HIV Protease Inhibitors / Q000009:adverse effects*; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D058456:Retinal Telangiectasis / Q000175:diagnosis / Q000209:etiology*; D019438:Ritonavir / Q000009:adverse effects*; D041623:Tomography, Optical Coherence; D014786:Vision Disorders; D014792:Visual Acuity
D017320:HIV Protease Inhibitors; D019438:Ritonavir