Department of Ophthalmology, Weill Cornell Medical College, New York, New York; and.
The Retina Institute of St. Louis, St Louis, Missouri.
Retina. 2024 Oct 1;44(10):1828-1835. doi: 10.1097/IAE.0000000000004175.
Antiretroviral therapy has revolutionized HIV treatment with didanosine (DDI) as a pioneering drug. However, DDI has been associated with retinal toxicity, characterized by peripheral chorioretinal degeneration with macular sparing. Despite its clinical recognition, the prevalence and risk factors for didanosine-induced retinopathy are not well described.
This retrospective case series analyzed 127 DDI-treated patients at Weill Cornell Medicine Department of Ophthalmology. Inclusion criteria included at least 6 months of DDI use and available ultra-widefield imaging. Patients were categorized as affected or unaffected based on retinal imaging assessed by two reviewers. The affected group was further divided into "probable" or "possible" retinopathy. Patient demographics, DDI usage characteristics, and imaging findings were analyzed with statistical comparisons drawn between affected and unaffected cohorts.
Of the 127 patients, 9 (7%) showed signs of didanosine-induced retinal toxicity. On average, the affected group was older compared with the unaffected group (65.1 vs. 56.5 years, P = 0.025), with lower BMI (23.2 vs. 27.4, P = 0.04), and older at the start of the treatment (51.6 vs. 40.8 years, P = 0.026). Mild phenotypes with peripheral pigmentary changes were also identified using ultra-widefield imaging.
This pioneering academic study highlighted a notable prevalence of DDI-induced retinal toxicity. Statistical analysis demonstrated age, BMI, and age at treatment initiation as potential risk factors. Ultra-widefield autofluorescence emerged as a valuable tool in detecting and delineating findings. Follow-up studies are needed to determine the necessity of regular screening for individuals on or with a history of didanosine use.
抗逆转录病毒疗法使叠氮脱氧胸苷 (DDI) 作为一种开创性药物彻底改变了 HIV 的治疗方法。然而，DDI 与视网膜毒性相关，其特征是周边脉络膜视网膜变性而黄斑未受累。尽管临床上已经认识到这种疾病，但 DDI 诱导的视网膜病变的患病率和危险因素尚未得到很好的描述。
本回顾性病例系列分析了威彻斯特康奈尔医学院眼科的 127 例 DDI 治疗患者。纳入标准包括至少使用 6 个月的 DDI 和可获得的超广角成像。根据两名审阅者评估的视网膜成像，将患者分为受影响和未受影响两类。受影响组进一步分为“可能”或“疑似”视网膜病变。分析了患者的人口统计学、DDI 使用特征和影像学表现，并对受影响组和未受影响组进行了统计学比较。
在 127 例患者中，有 9 例（7%）出现了 DDI 诱导的视网膜毒性迹象。受影响组的平均年龄明显大于未受影响组（65.1 岁 vs. 56.5 岁，P = 0.025），体重指数（BMI）较低（23.2 岁 vs. 27.4 岁，P = 0.04），治疗开始时的年龄也较大（51.6 岁 vs. 40.8 岁，P = 0.026）。使用超广角成像也发现了轻度的周边色素变化。
这项开创性的学术研究强调了 DDI 诱导的视网膜毒性的显著患病率。统计分析表明，年龄、BMI 和治疗开始时的年龄可能是潜在的危险因素。超广角自发荧光成像已成为检测和描绘发现的有用工具。需要进一步的随访研究来确定是否需要对正在使用或有 DDI 使用史的个体进行常规筛查。
