Elvitegravir/cobicistat-associated toxic optical neuropathy in an HIV-infected patient: a call for caution?
Ocular toxicity may not only be caused by medication overdoses and drug-drug interactions, but also by chronic administration of medications at recommended doses. We describe a case of an HIV-infected patient who experienced significant and sustained bilateral visual loss 2 months after starting treatment with elvitegravir/cobicistat/tenofovir/emtricitabine. Given the absence of any evidence of tenofovir- or emtricitabine-induced optical neuropathy after several years of clinical use, the antiretroviral therapy was promptly changed to tenofovir/emtricitabine plus atazanavir/ritonavir, which led to a progressive improvement in visual acuity. However, visual evoked potentials never returned to normal amplitudes. This is the first report of toxic optical neuropathy associated with the use of elvitegravir/cobicistat. It is imperative to recognize any signs of possible eye toxicity as rapidly as possible, and refer affected patients to an ophthalmologist promptly because early detection and the withdrawal of the offending agent are crucial in reversing this adverse ocular event.
3rd Division of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy.
Agostino
A
Riva
Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco University Hospital, Milan, Italy.
Alessandro
A
Invernizzi
3rd Division of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy.
Chiara
C
Resnati
Clinical Microbiology, Virology and Diagnosis of Bioemergency, Luigi Sacco University Hospital, Milan, Italy.
Valeria
V
Micheli
Unit of Clinical Pharmacology, Luigi Sacco University Hospital, Milan, Italy.
Dario
D
Cattaneo
3rd Division of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy.
Cristina
C
Gervasoni
D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods; D018791:CD4 Lymphocyte Count; D000069547:Cobicistat / Q000009:adverse effects* / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000209:etiology*; D015363:Quinolones / Q000009:adverse effects* / Q000627:therapeutic use; D019562:Viral Load
D015363:Quinolones; C509700:elvitegravir; D000069547:Cobicistat