Didanosine-Associated Retinal Toxicity (DART) Amongst HIV-Positive Patients: a Case Series and Literature Review

The aim of this study is to report on didanosine-associated retinal toxicity (DART) in four adult patients with human immunodeficiency virus (HIV) identified incidentally during routine diabetic eye screening and review all reported cases to date. This study is a retrospective, observational, case series from two health institutions with a review of published literature. DART is often asymptomatic, and patients have good vision (mean visual acuity 6/9), but in advanced cases, severe visual field defects can occur. Fundal changes range from mild granular pigmentary mottling to patches of mid-peripheral chorioretinal atrophy. Continuous expansion of chorioretinal degenerative changes posteriorly may lead to significant macular involvement as demonstrated in two of our cases. Despite cessation of therapy, DART was progressive in approximately 25% of reported cases. Our cases were incidentally discovered during routine diabetic eye screening and did not report any ocular symptoms prior to referral. Given the initial asymptomatic nature of DART, we believe that the true prevalence of the disease may be higher than previously thought. It may be prudent to screen and follow-up patients with a history of DDI use. We demonstrate the utility of multimodal imaging, optical coherence tomography, electrodiagnostic testing and visual fields in evaluating the effects of DART.