Ophthalmologic Complications in Children With Chronic Hepatitis C Treated With Pegylated Interferon

Abstract

Objectives Interferon treatment for chronic viral hepatitis C (HCV) has been associated with the development of retinopathy in 19–29% of adults. Our purpose is to describe the ophthalmological complications of pegylated interferon (PEG) α2a with either placebo or ribavirin in children with chronic HCV (THE PEDS-C TRIAL). Methods Prospective comprehensive ophthalmologic examinations including slit lamp at enrollment and after 24 and 48 weeks of treatment of 114 children participating in a randomized clinical trial. Results 128 children were screened for entry of which 123 had an eye exam and no child had existing retinal disease. 114 children were eligible and were treated. 110 children had an eye exam at 24 weeks and 103 at 48 weeks. 3 of 114 subjects (2.6%) developed documented (n=2) or possible (1) serious eye complications: One developed evidence of ischemic retinopathy (cotton wool spots) by week 24, one developed uveitis by week 48, and one reported at week 48 transient (<4 hours) monocular blindness that had occurred at week 36 with a subsequent normal exam at week 48. Conclusions Ophthalmologic complications are infrequent in children who are treated with PEG α2a for HCV (2–3%). Because of the potential severity of ischemic retinopathy and uveitis, prospective ocular assessment should remain part of the monitoring strategy for children who are treated with interferon for HCV.

Hepatitis C

“…This typically returns to normal after cessation of therapy 36 The effect on height can be noted up to 2 years after end of treatment Peginterferon 2a is associated with retinopathy or uveitis in 2% to 3% of patients 37 We recommend a baseline ophthalmologic examination and repeat examinations if symptoms develop Neutropenia can be marked, but clinical infections are uncommon Ribavirin has side effects, including:…”

Management of chronic hepatitis C infection in children

“…This gene encodes interferon lambda, a cytokine with antiviral activity. In adults, it has been recognized that single nucleotide polymorphisms in the IL 28B gene are associated with a SVR to treatment with PEG-IFN and RBV, as well as an increased likelihood of spontaneous viral clearance [28,29]. The likelihood of viral response or clearance is the highest with genotype CC, whereas genotype TT portends the least favorable outcome.…”

“…Eye complications are rare at baseline in children with HCV and occur in 2-3% of children treated with PEG-IFN. Retinopathy is seen in 1% of children as compared with approximately 20-30% of treated adults [29]. PEG-IFN has also led to growth problems when used in young children [9].…”

Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children

“…73 Ophthalmologic complications have been reported in clinical trials of children with pegylated IFN. 74 Neutropenia, which resolves after discontinuation of therapy, is the most common laboratory abnormality; anemia and thrombocytopenia are less common. Abnormalities in thyroid function (hypothyroidism or hyperthyroidism) have been reported with IFN-α therapy.…”