Association of Ledipasvir-Sofosbuvir Treatment With Uveitis in Patients Treated for Hepatitis C

Abstract

ince 2014, combination therapy containing sofosbuvir has been the standard of care for the treatment of chronic hepatitis C (HCV) infection. 1 One of the most common combinations is ledipasvir-sofosbuvir (Harvoni [Gilead Sciences]), which has a cure rate of up to 99% for chronic genotype 1 HCV infection. 2 These newer-generation antiviral medications have substantially changed the prognosis of patients infected with HCV.While interferon treatment has been known to cause retinal vasculopathy, 3 hepatitis C infection itself has not been associated with uveitis or retinopathy. Sofosbuvir has previously been associated with impairment of tear function and squamous metaplastic changes to the ocular surface. 4 Additionally, to our knowledge, there has been 1 reported case 5 of acute anterior nongranu-lomatous uveitis and cotton wool spots after initiation of ribavirin and sofosbuvir. We report a series of 6 patients who presented with new, predominantly posterior uveitis after initiation of or completed treatment with ledipasvir-sofosbuvir. MethodsAll patients in this study consented to the presentation of deidentified information pertaining to their pathology. All participants were treated in accordance with the Declaration of Helsinki. Institutional review board exemption was granted by Wayne State University.IMPORTANCE Ledipasvir-sofosbuvir has become the current standard of care for hepatitis C since its release in 2014. Therefore, potential adverse effects are important to identify.OBJECTIVE To report findings of uveitis after treatment with ledipasvir-sofosbuvir for hepatitis C. DESIGN, SETTING, AND PARTICIPANTSThis case series includes patients treated in an urban academic setting with ledipasvir-sofosbuvir for hepatitis C from June 2015 to June 2017 who are known to have developed signs and symptoms of posterior uveitis.EXPOSURES All patients had been treated with ledipasvir-sofosbuvir for hepatitis C for a total of 12 weeks. All patients but 1 had finished treatment prior to presentation. MAIN OUTCOMES AND MEASURES Signs of posterior uveitis on ophthalmic testing.RESULTS Data were collected from 6 patients (median age, 64.5 [range, 54-72] years). Five patients were male; 4 were white, and 2 were African American. The mean (SD) time between beginning of treatment and presentation was 8.8 (5.5) months. Both eyes were affected in 3 of the 6 patients (total, 9 eyes). The median presenting visual acuity in affected eyes was 20/40 (range, 20/20-20/70). All patients had a negative systemic uveitis workup. Five patients presented with blurred vision, and 1 had a paracentral scotoma. The main ocular findings were peripheral vasculitis (in 8 of 9 eyes), papillitis (in 7 of 9 eyes), and cystoid macular edema (in 6 of 9 eyes). The median follow-up was 8 (range, 4-13) months. The median final visual acuity was 20/40 (range, 20/20-20/200). CONCLUSIONS AND RELEVANCEIn these patients, it appears that treatment with ledipasvir-sofosbuvir for hepatitis C was associated with a mild posterior uveitis different than interferon ret...