Hepatitis C Regimen Can Cause Cataracts

Interferon-ribavirin therapy was the standard of care prior to the advent hepatitis C virus (HCV)-specific antivirals in 2011. Hepatitis C itself causes cataract-inducing systemic oxidative stress. Small studies suggest interferon alpha and ribavirin have additive pro-inflammatory effects.

Interferon causes retinopathy but the literature rarely reports cataracts outside its use in HCV infection. The FDA reports a slight 0.5% of patients with HCV who develop a cataract during ribavirin therapy. Interferon-ribavirin associated adverse events include reversible alopecia, anorexia, fatigue, myalgia, nausea, and pruritus but cataracts remain after treatment. The American Academy of Family Physicians briefly noted providers should mention visual adverse effects during counseling in their 2005 guidelines.¹

A team of researchers from Taiwan noted that HCV infection, particularly if treated with interferon-ribavirin, increases cataract risk in a new study published on March 7, 2017 by PLoS One.²

The study followed 11,652 patients with HCV and 46,608 age- and sex-matched patin non-HCV infected patients from 2003 until 2011, cataract diagnosis, or death. The authors conducted Kaplan-Meier curve analysis and log-rank testing to compare the relative cataract hazard ratios of the infected and uninfected groups.

Patients with HCV, with or without cirrhosis, have increased cataract risk, especially if receiving interferon-ribavirin therapy. Hepatitis C alone increased cataract risk by 29% compared to healthy patients and the addition of these 2 older medications tripled the increased risk.

The investigators identified advanced age, diabetes, and hyperlipidemia as other risky variables. However interferon-ribavirin therapy was independently associated with cataracts. Cirrhosis, indicative of severe disease-related oxidative stress, had no effect on cataract development. Family history, smoking history, vitamin supplement use, ultraviolet exposure, and sun protection cataract risk data was unavailable.

This study drew its data from the era before newer direct-acting antivirals therefore a comparison to these medications was not possible. Future research should identify if this cataract risk extends to newer therapies.

The dangers posed by untreated HCV infection outweighs the uncommon risk of surgically treatable and non-life threatening cataracts. Therefore, cataract risk should not dissuade patients from undergoing HCV cure but monitoring and counseling should include eye testing.

Works Cited

1. Ward RP, Kugelmas M. Using pegylated interferon and ribavirin to treat patients with chronic Hepatitis C. Am Fam Phys. 2005; 72(4):655-662.

2. Lin SY, Lin CL, Ju SW, et al. Increasing risk of cataract in HCV patients receiving anti-HCV therapy: A nationwide cohort study. PLoS One. 2017; 12(3): e0173125. doi:10.1371/journal.pone.0173125.