Patients with Hypertension and Diabetes Mellitus Undergoing Interferon Therapy for Treatment of HCV Are Not at Higher Risk To Develop Ophthalmologic Complications

Abstract

Purpose: To determine the frequency and risk factors related to interferon-associated ophthalmologic complications during treatment for hepatitis C. Methods: Review of records from a cohort of patients undergoing HCV treatment between January 2005 and May 2007. Patients were treated with ribavirin in addition to either pegylated INF α-2a, α-2b or consensus INF. A mandatory, baseline ophthalmologic examination was performed on each patient prior to initiation of treatment. Data recorded included genotype, treatment duration, type of INF used, presence of prior eye disease/complaints, presence of DM / HTN, visual complaints during treatment and findings at baseline and follow-up eye exams. Any visual complaints during therapy prompted immediate evaluation by an eye specialist. Results: A total of 183 patients treated for HCV were included in the study cohort. Seventy-one (38.7%) received interferon α-2a, 100 α-2b (54.6%) and 12 (6.5%) consensus INF. Treatment duration was 1 to 48 weeks (mean = 27.6). Age range was 31 to 72 years (mean = 52.9) and 95% were men. Twenty-nine (15.8%) had DM, 85 (46.2%) HTN and twenty-one (12.5%) had both DM and HTN. One patient with DM + HTN had retinopathy (cotton wool spots) at baseline exam. During treatment 16 (8.7%) had visual complaints, but only 3/16 (18.75%) found to have retinal changes. In addition 4 (2.2%) asymptomatic patients had retinopthay on routine follow-up examinations. Overall 7 (3.82%), (6 during treatment) had documented retinal changes (6 CWS, 1 optic neuritis). Of 7 with retinal changes, 1 (14.2%) had DM, 3 (42.8%) HTN and 1 (14.2%) had both. Of these, 5 were on α-2b and 2 on α-2a. Three patients required treatment discontinuation 44, 20 and 2 weeks earlier than scheduled. These included asymptomatic worsening CWS(1), symptomatic CWS(1) and symptomatic optic neuritis (1). Conclusion: In our study, both the incidence of symptomatic retinopathy and resultant treatment discontinuation rate appears very low 3/183 (1.63%) during treatment with PEG INF/ribavirin. The majority of patients who experienced visual symptoms during treatment had no evidence of retinopathy (81%). Diabetes and hypertension do not appear to be predictors for the development of clinically significant interferon-associated retinopathy.