Sir,

We are writing in response to the case report by Curi AL et al1 in the April 2001 edition of Eye.

The article in question was regarding an HIV-positive patient who developed a bilateral visual loss. It is reported that the patient started on Efavirenz (a non-nucleoside reverse transcriptase inhibitor) in March 1999. Three months later he began to experience blurred vision. The Efavirenz was discontinued, but the patient’s vision continued to deteriorate to a visual acuity of 6/60 in both eyes. The case report notes ‘ophthalmoscopy showed an area of retinal opacification occupying most of his macula in both eyes’.

The authors have attributed this visual loss to Efavirenz.

In a large primary and tertiary referral centre in London (Chelsea and Westminster Hospital), 683 patients have received Efavirenz since December 2000 as part of their HIV treatment. Only 19 of the 683 patients on Efavirenz have had ocular symptoms requiring review. None of these patients have any signs or symptoms corresponding with those reported as Efavirenz toxicity. The ocular pathology found in these cases was attributable to CMV disease (excluding the case of Best Vitelliform Macular Dystrophy) and is represented in Table 1.

Table 1 Ocular pathology of patients on Efavirenz in the HIV ophthalmology department at Chelsea and Westminster Hospital
Full size table

Efavirenz is a relatively new drug. To date its known side effects are neuropsychological (dizziness/light-headedness, vivid dreams/nightmares) and dermatological (skin rash). Of 683 patients treated with Efavirenz at this centre, none had ocular pathology attributable to the drug itself.

These findings would lead us to conclude that many patients are being treated with Efavirenz with no ocular side effects and that perhaps the findings reported by Curi AL et al1 are not related to the drug.