Abstract
Some reports described a possible ritonavir-related retinal toxicity. The objective of this research was to review and analyze previous studies conducted on ritonavir administration and retinal impairment in a narrative synthesis. PubMed was used to perform a systematic review of ritonavir effects and retinal damage. All studies up to December 2019 were considered. Seven single cases and one case series, reporting a total of 10 patients affected by retinal changes secondary to long-term ritonavir treatment, were included in the review. Variable degrees of outer retina and retinal pigment epithelium changes were detected in most of the patients, with two patients showing macular telangiectasia, four patients presenting intraretinal crystal deposits, two patients disclosing a bull's eye maculopathy, and two patients revealing midperipheral bone spicule-like pigment changes. In the present study, we hypothesized that the use of ritonavir in life-saving treatments of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pneumonia might expose these patients to the risk of developing a retinotoxicity. We aimed to alert ophthalmologists on the importance of recognizing ritonavir-induced retinal impairment in SARS-CoV-2 patients. These findings are the target for personalized medicine.
Highlights
Ritonavir is a human immunodeficiency virus type 1 (HIV1) protease inhibitor, approved by the Food and Drug Administration in 1996 to be used in the highly active antiretroviral therapy (HAART), which is recognized as the most effective treatment method for human immunodeficiency virus (HIV) patients.In light of the benefits produced by ritonavir in combination with lopinavir in the treatment of severe acute respiratory syndrome and Middle East respiratory syndrome, the association lopinavir/ritonavir has been integrated in the treatment guidelines of 2019 novel coronavirus (2019-nCoV) infected pneumonia [1] with a weak recommendation level [2]
Ritonavir appears to exert a toxic effect on the outer retina and retinal pigment epithelium (RPE), causing their irreversible degeneration in the long term and threatening the central vision without therapeutic options available
Us, we aimed to alert ophthalmologists on the possible retinal damage that might occur in some patients hospitalized for SARS-CoV-2 pneumonia and treated with ritonavir
Summary
Ritonavir is a human immunodeficiency virus type 1 (HIV1) protease inhibitor, approved by the Food and Drug Administration in 1996 to be used in the highly active antiretroviral therapy (HAART), which is recognized as the most effective treatment method for human immunodeficiency virus (HIV) patients.In light of the benefits produced by ritonavir in combination with lopinavir in the treatment of severe acute respiratory syndrome and Middle East respiratory syndrome, the association lopinavir/ritonavir has been integrated in the treatment guidelines of 2019 novel coronavirus (2019-nCoV) infected pneumonia [1] with a weak recommendation level [2]. Ritonavir is a human immunodeficiency virus type 1 (HIV1) protease inhibitor, approved by the Food and Drug Administration in 1996 to be used in the highly active antiretroviral therapy (HAART), which is recognized as the most effective treatment method for human immunodeficiency virus (HIV) patients. A recent randomized trial [3] involving hospitalized adult patients with confirmed severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection has not shown significant benefits with lopinavir/ritonavir treatment beyond standard care, this protease inhibitor association is used in worldwide hospitals [4]. As an HIV-1 protease inhibitor, ritonavir prevents the cleavage process of viral polyprotein precursors into mature and functional proteins, interrupting the production of new viral particles. E CYP450-3A4 pathway metabolizes other protease inhibitors. For this reason, coadministration of low-dose ritonavir with other protease
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