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PEG-IFN treatment in hypertensive patients with HCV may cause retinopathy

Patients with chronic hepatitis C, particularly those with hypertension, were prone to developing retinopathy during treatment with pegylated interferon alpha and ribavirin in a recent study.

Ninety-seven patients with chronic HCV received either pegylated interferon alpha (PEG-IFNa) 2a (n=54) or 2b (n=43) with ribavirin, and underwent ophthalmologic examination at baseline, after 3 and 6 months of treatment, and again 3 months after treatment cessation. The 2a dose was a subcutaneous injection of 180 mcg administered once weekly, while the 2b dose was based on patient weight.

Retinopathy developed in 30 participants (30.9%), including one case of bilateral branch retinal vein occlusion that resulted in discontinuation of treatment. Eighteen (60%) of the retinopathy cases disappeared after treatment cessation. Among nine patients with retinopathy at baseline, all experienced worsening symptoms during treatment.

Investigators established significant associations between retinopathy and hypertension (P<.0001), advanced age (P=.004), the presence of intraocular lesions at baseline (P=.01), metabolic syndrome (P=.05) and cryoglobulinemia (P=.05). Of these factors, only hypertension (n=27 across both groups) was independently associated with retinopathy through multivariate analysis (HR=4.99; 95% CI, 2.29-10.89). The difference in retinopathy frequency between the two groups was not statistically significant (29.6% of 2a compared with 32.6% of 2b, P=.7).

Patients with hypertension were significantly more prone to retinopathy than nonhypertensive participants at all examinations:

• 18.5% compared with 5.7% at baseline examination, P=.05
• 48.1% compared with 15.7% after 3 months of treatment, P=.0009
• 68% compared with 19.1% after 6 months of treatment, P<.0001
• 32% compared with 6.2% at 3 months following treatment, P=.0005

“PEG-IFNa-associated retinopathy is frequent during antiviral treatment for [chronic HCV], especially in hypertensive patients, who may develop serious complications,” the researchers wrote. “Screening for PEG-IFNa-associated retinopathy should be recommended when hypertension coexists.”