Retinopathy Is Common with Interferon Therapy for HCV Infection

Ophthalmologic screening is warranted in patients with hypertension.

Interferon-based therapy is currently the standard treatment for hepatitis C virus (HCV) infection and likely will be for the near future. Retinopathy has been associated with interferon therapy, but few studies have described its frequency or clinical significance.

In this prospective, longitudinal study, the occurrence of retinopathy was evaluated in 97 consecutive patients at a single center who received treatment for HCV infection with interferon and ribavirin for 48 weeks. All patients underwent extensive ophthalmologic examinations at baseline, 3 months, 6 months, and 3 months posttreatment. Retinopathy was defined as the presence of cotton wool spots, retinal hemorrhages, or microaneurysms.

During therapy, retinopathy occurred in 31% of patients, including nine (9.3%) with retinopathy at baseline. In univariate analysis, age, hypertension, preexisting intraocular lesions, metabolic syndrome, and cryoglobulinemia were associated with retinopathy. In multivariate analysis, only hypertension remained a significant risk factor (hazard ratio, 4.99; 95% confidence interval, 2.29–10.89). The frequency of retinopathy increased with successive ophthalmologic examinations and was consistently higher for patients with hypertension than for others, peaking at 68% and 19% respectively at the 6-month exam. Thirty percent of patients complained of visual disturbances. One patient (1.1% of the cohort) had persistent long-term vision loss and was discontinued from therapy at 6 months. This patient had baseline preexisting retinopathy.

Comment: This prospective study is one of the few to specifically address the issue of interferon-induced retinopathy. Approximately one third of patients developed or experienced worsening of baseline retinopathy during therapy. Moreover, patients with hypertension had a fivefold higher incidence of retinopathy than those without hypertension. Permanent visual problems developed in only one patient, who was hypertensive with baseline retinopathy. These findings support ophthalmologic examinations in patients with HCV infection and hypertension who are about to undergo interferon-based therapy.

— Atif Zaman, MD, MPH

Published in Journal Watch Gastroenterology September 14, 2012

Citation(s):

Vujosevic S et al. Pegylated interferon-associated retinopathy is frequent in hepatitis C virus patients with hypertension and justifies ophthalmologic screening. Hepatology 2012 Aug; 56:455.

Medline abstract (Free)

Source