Didanosine-induced Retinopathy: New Insights with Long-term Follow-up

ABSTRACT

Introduction

Didanosine is an adenosine analog, part of the nucleoside reverse-transcriptase inhibitor family. Since the description of didanosine-induced retinopathy in the early 1990s, little is known about the progression of this toxic retinopathy and the putative underlying mitochondrial defect.

Objectives

We report long-term follow-up for cases of didanosine-induced retinopathy and discuss a new hypothesis for pathophysiology based on the alteration of endogenous adenosine on the photoreceptor outer segment turnover and phagocytosis by the retinal pigment epithelium.

Methods

Ophthalmic data from six cases (12 eyes) of didanosine-induced retinopathy from a single institution were retrospectively analyzed.

Results

All patients displayed bilateral retinal alterations in the mid-periphery. Despite didanosine discontinuation, patients with advanced areas of patchy chorioretinal atrophy appeared to have a faster progression than those with limited lesions. Full-field electroretinogram revealed generalized rod-cone dysfunction in most cases that remained stable over time.

Conclusion

We propose new guidelines including early screening and long-term observations.

KEYWORDS:

• Adenosine
• Didanosine
• electroretinography
• human immunodeficiency virus
• nucleoside analog reverse-transcriptase inhibitors
• purine analog
• retinal pigment epithelium
• rod-cone dysfunction
• tenofovir
• toxic retinopathy

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Role of the funder/sponsor

The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional information

Funding

IHU FOReSIGHT [ANR-18-IAHU-0001] supported by French state funds managed by the Agence Nationale de la Recherche within the Investissements d’Avenir program.