Efavirenz
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Efavirenz Retinal toxicity in the form of defective night vision, ceco-central scotoma and color vision defects: 5 case reports
In a study, five patients (4 men and 1 woman) aged 33–51 years were described, who developed retinal toxicity in the form of defective night vision, ceco-central scotoma or color vision defects following treatment with efavirenz for human immunodeficiency virus (HIV) [routes and dosages not stated; not all times to reactions onsets stated]. Case 1: A 39-year-old man had a history of hepatitis-B infection and HIV. He presented for defective night vision in both eyes for two months. He had been receiving tenofovir, lamivudine and efavirenz for three months. The best corrected visual acuity was found to be 6/12, N10 in the right eye and 6/6, N6 in the left eye. Slit lamp examination exhibited a quiet anterior chamber. Humphrey’s visual field by 30-2 showed ceco-central scotoma in the right eye while left eye exhibited generalised reduced sensitivity. Right eye fundus examination exhibited dull foveal reflex while left eye was normal. Color vision in the left eye was normal while right eye was 1/21 by Ishihara plates. Right eye optical coherence tomography showed sub retinal fluid (SRF) in the macular area, and left eye was normal. Fundus fluorescein angiography showed speckled hyperfluorescence in the papillomacular bundle with a single leak in the late phase. Electroretinogram exhibited non-recordable rod response, normal photopic response in both eyes and reduced ’B’ wave in combined response. Based on investigation findings, a possibility of efavirenz-related retinal involvement was considered. Therefore, efavirenz was switched to nevirapine. Tenofovir and lamivudine were continued. At a 3-month follow-up, his visual acuity improved with normal color vision. Electroretinogram and optical coherence tomography exhibited normal results for boht the eyes. Case 2: A 33-year-old man had a history of hepatitis-B infection and HIV. He presented with defective vision during night in the left eye for 10 days. He had been receving tenofovir, lamivudine and efavirenz since a month. His right eye was phthisical since childhood due to unknown reason. The best corrected visual acuity (left eye) was found to be 6/12, N8. Slit lamp and fundus (left eye) were within normal limits. Color vision of left eye was 1/21 by Ishihara plates. Electroretinogram left eye demonstrated nonrecordable single flash rod responses, normal photopic responses and grossly reduced combined responses. Visual fields exhibited generalised reduction of sensitivity. Based on investigation findings, a possibility of efavirenz-related retinal toxicity was considered. Therefore, efavirenz was changed to atazanavir. Following two months, his night vision improved. Electroretinogram showed normal results with normal photopic and scotopic responses. Eventually, he succumbed to hepatic failure. Case 3: A 48-year-old woman had a history of hepatitis-B infection and HIV. She presented with defective vision in both eyes for 20 days. A mo
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