Ptosis in Long-Term HIV Patients: A Clinical Marker of Mitochondrial Toxicity from Antiretroviral Therapy ?
Author: Benjamin MATAGRIN
Base Hospital / Institution: CHU de Lyon Hôpital Edouard Herriot
ePoster presentation
Abstract ID: 25-320
Purpose
Assess whether ptosis in HIV patients is linked to acquired mitochondrial myopathy from prolonged NRTI exposure, through surgical, histopathological, and genetic analysis.
Methods
We conducted a retrospective-prospective observational study at the Orbital and Eyelid Surgery Department, Fondation Adolphe de Rothschild, Paris. We included 62 HIV-positive patients with uni- or bilateral ptosis treated between 2012 and 2024. Demographic, clinical, virological, and treatment data were collected. Comprehensive ophthalmological examination and neurologic assessment were performed. Surgical management included anterior levator resection, Mullerectomy, or frontalis suspension. In selected cases, intraoperative levator biopsies were analyzed histologically and genetically.
Results
Among 62 patients (109 eyelids), the mean age was 68.7 years, and 75.8% had bilateral ptosis. Surgery was performed in 75% of cases, mainly anterior levator resection (79.5%). The surgical revision rate was 17.1%. Histologic analysis showed mitochondrial alterations in one case, confirmed by genetic testing. Neurological assessments revealed ophthalmoplegia/diplopia (31.2%), peripheral neuropathy (22%), and pigmentary retinopathy (6.4%). Most patients had long-term NRTI exposure, with a shift from first-generation to second-generation NRTIs after 2000.
Conclusion
Our study highlights ptosis as a potential clinical marker of acquired mitochondrial toxicity in long-term HIV patients, resembling congenital syndromes such as CPEO or Kearns-Sayre. Surgical correction remains effective, and multidisciplinary evaluation is key to identifying broader mitochondrial manifestations.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Marie | Callet | Fondation Rothschild |
| Pierre-Vincent | Jacomet | Fondation Rothschild |
| Mathieu | Zmuda | Fondation Rothschild |
| Sophie | Azria | Fondation Rothschild |
| Paul | Benilouche | Fondation Rothschild |
| Olivier | Galatoire | Fondation Rothschild |
