HIV drugs show promising vision loss in diabetes

According to results from Brazil’s clinical trials, a cheap HIV drug, which is less than $20 a month, could provide new hope for millions of people with diabetes eye disease.

Compared with existing treatments, patients with diabetic macular edema improve vision of diabetic macular edema (which is the main cause of diabetic blindness), spends $2,000 per month more efficiently than existing treatments, and requires direct injection of pain.

The disease affects the phenomenon of 14 of about 14 people suffering from diabetes, threatening the 37 million American adults suffering from the disease. Current treatments involve monthly injections that pose a risk of infection and retinal detachment.

Oral alternatives to inject eyes

“A oral medication that improves DME vision is a game-changer because it is more convenient for patients than frequent (usually once a month) injections of the eyes,” said Jayakrishna Ambati, Physician, founding director of the Center for Advanced Vision Science at UVA Health. “The mechanism of action of lamivudin is also different from existing treatments, so we can also develop combination therapies.”

Diabetic macular edema occurs when fluid accumulates in the retina (photosensitive tissue on the back of the eye). This swelling can distort your vision and, if left untreated, can lead to permanent blindness.

The randomized clinical trial was conducted at the University of São Paulo, the federal federal federal Brazil, which enrolled 24 adults with this condition. Participants received lamivudine or placebo for eight weeks and had added bevacizumab after four weeks of injection.

Dramatic vision improvement

The results are surprising. Patients who can take Lamivudine alone improved their ability to read letters with 9.8 letters (about two full lines) after just four weeks. Meanwhile, those who received the placebo actually lost 1.8 vision during the same period.

These improvements become more pronounced when used in combination with bevacizumab injections. Eight weeks later, the recipient of Ramifdin received 16.9 video letters, more than three lines on the eye chart. The placebo group that received bevacizumab injections only improved by only 5.3 letters.

These improvements suggest that Lamivudine is both independent and incorporating existing treatments, although a large number of studies are required to confirm the findings.

Global Health Game Changeler

Cost differences may be a change in the global healthcare system. Current anti-VEGF treatments such as Aflibercept and Ranibizumab are among the top five drugs in Medicare spending, with a monthly cost of $2,000 per injection.

“A oral pill of $20 per month, which costs up to $2,000 per month, is transformable for patients and health care systems,” Ambati notes.

The meaning goes far beyond cost savings. Many patients in developing countries do not have access to ophthalmologists who can get monthly injections of their eyes. Oral medications can make treatment available to more patients around the world.

Key research results:

• Ramifdin alone improves vision by 9.8 letters after 4 weeks
• Combined with bevacizumab, the improvement reached 16.9 letters after 8 weeks
• There was no significant difference in adverse events between the treatment groups
• The monthly fee may be $20, while the current treatment is $2,000
• Oral administration eliminates injection-related complications

Inflammatory connection

What makes this finding particularly interesting is that lamivudin works differently from existing treatments. Although current therapies target vascular leakage by blocking growth factors, lamivudin appears to protect retinal neurons and block inflammasomes—a protein complex in the immune system that is often detected in the immune system but has been associated with diabetic eye disease.

This dual mechanism of neuronal dysfunction and vascular problems in diabetic retinopathy represents a fundamentally different treatment approach. The drug blocks the formation of the purinergic receptor P2X7 wells and activates specific inflammasomes, all of which lead to the progression of diabetic retinopathy.

Synthetic control analysis showed another key finding: lamivudine was performed as well as expensive treatments compared to historical data from major clinical trials and was significantly better than bevacizumab or Ranibizumab. This suggests that HIV drugs can match or exceed the performance of standard care at a fraction of the cost.

Beyond Diabetes

The findings build on previous studies by Ambati, suggesting that HIV drugs may have broader medical applications. His team recently discovered that these drugs, called nucleoside reverse transcriptase inhibitors, can significantly reduce the risk of Alzheimer’s disease and may also reduce the risk of diabetes and macular degeneration.

“We have developed a safer version of Lamivudine called K9, which blocks inflammation without the potential side effects of Lamivudine,” Ambati said. “So we are excited about the ongoing and planned clinical trials of K9 in DME.”

The study illustrates what Ambati calls “big data archaeology” – a large health care database that curates to discover new uses of existing drugs. This approach has generated multiple promising potential customers repurposing established drugs.

What’s next?

Although the initial results are encouraging, the researchers acknowledge their research limitations. The trial was small and lasted only eight weeks, over a relatively short period of time for the patient. Future research will require recruiting more participants and tracking them over a longer period of time to fully establish the safety and efficacy of lamivudin.

However, the researchers found encouraging signs that Lamivudine benefits are beyond the typical surrounding window when most DME improvements occur. Vision continued to improve between weeks 5 and 8, indicating a sustained therapeutic effect.

For millions of people facing progressive vision loss with diabetes eye disease, Ramifdin not only represents another treatment option, but it can democratize access to effective treatment regardless of geographical or economic conditions. Whether this HIV drug will eventually change diabetes care remains to be seen, but early evidence suggests that we may be witnessing the beginning of a new chapter to treat one of the most devastating complications of diabetes.