didanosine and Retinal-Diseases

To assess the safety and antiretroviral activity of 2',3'-dideoxyinosine, we enrolled 43 children with symptomatic (Centers for Disease Control class P-2) human immunodeficiency virus infection in a Phase I-II study and monitored them prospectively for the development of ocular complications secondary to HIV infection or drug toxicity. Follow-up ranged from 12 to 103 weeks with a median follow-up of 71 weeks. Three of 43 children (7.0%) developed peripheral atrophy of the retinal pigment epithelium during treatment with 2',3'-dideoxyinosine. The two children with the most severe retinal atrophy were enrolled in the study at the highest dosage studied (540 mg/m2/day). In contrast to findings in children, no retinal atrophy in HIV-infected adults treated with 2',3'-dideoxyinosine has been evident to date.

Topics: Atrophy; Child; Child, Preschool; Didanosine; Drug Evaluation; Electrooculography; Electroretinography; Female; Follow-Up Studies; Fundus Oculi; HIV Infections; HIV-1; Humans; Male; Pigment Epithelium of Eye; Prospective Studies; Retina; Retinal Diseases; Zidovudine

To present the multimodal retinal imaging findings in didanosine retinopathy in a patient who presented 6.5 years after stopping the use of didanosine and to highlight the absence of progression during a 1.5-year follow-up.. Case report involving clinical examination, fundus photography, fundus autofluorescence, fluorescein angiography, optical coherence tomography, Goldmann kinetic perimetry, and full-field electroretinography.. A 52-year-old patient presented with bilateral retinopathy 6.5 years after stopping didanosine having used the medication for 8.5 years. Fundus examination showed a ring-shaped zone of atrophy of the retinal pigment epithelium involving the midperiphery. On autofluorescence imaging, there was diffuse hypoautofluorescence involving the midperipheral retina in both eyes. On fluorescein angiography, there was a granular mottled pattern of diffuse hyperfluorescence in the midperiphery in both eyes, with baring of the large choroidal vessels in some areas. On Goldmann kinetic perimetry, both eyes showed marked constriction of the isopter to the I4e stimulus, and there was a temporal scotoma to the III4e target in both eyes. Full-field electroretinography showed generalized rod and cone photoreceptor dysfunction in both eyes. During a follow-up for 1.5 years, there was no evidence of progression.. Patients who have used didanosine should be evaluated for the presence of retinopathy, which involves the midperipheral retina.

Topics: Anti-HIV Agents; Didanosine; Drug-Related Side Effects and Adverse Reactions; Electroretinography; Female; Fluorescein Angiography; Humans; Middle Aged; Multimodal Imaging; Retina; Retinal Diseases; Tomography, Optical Coherence; Visual Acuity; Visual Field Tests; Visual Fields

Topics: Didanosine; Female; HIV Infections; Humans; Hypertension, Portal; Liver; Middle Aged; Retina; Retinal Diseases; Reverse Transcriptase Inhibitors; Treatment Outcome

Topics: Anti-HIV Agents; Didanosine; Electroretinography; HIV Infections; Humans; Male; Middle Aged; Retinal Diseases

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Didanosine; Female; Humans; Male; Middle Aged; Retinal Diseases; Retinal Vessels; Reverse Transcriptase Inhibitors; Zidovudine

Didanosine, a purine analogue with antiretroviral activity, is used in the treatment of human immunodeficiency virus disease. Associated toxic effects of didanosine include pancreatitis, peripheral neuropathy, and retinopathy. The retinal lesions associated with didanosine therapy were studied in a 6-year-old girl with acquired immunodeficiency syndrome. Gross examination disclosed multiple well-circumscribed depigmented lesions in the midperipheral retina. Microscopic examination of these lesions showed multiple areas of retinal pigment epithelial (RPE) loss, some surrounded by areas of hypertrophy or hypopigmentation of the RPE. Partial loss of the choriocapillaris and neurosensory retina were also noted in areas of diseased RPE. Transmission electron microscopy showed numerous membranous lamellar inclusions and cytoplasmic bodies in the RPE cells. These data show that didanosine primarily affects the RPE and that the choriocapillaris and overlying neurosensory retina are also dystrophic in areas of RPE loss.

Topics: Child, Preschool; Choroid Diseases; Didanosine; Female; HIV Infections; Humans; Hypertrophy; Pigment Epithelium of Eye; Retinal Diseases

Topics: Child; Didanosine; Female; HIV Infections; Humans; Retinal Diseases