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Margusino-Framiñán L, Bobadilla-Pérez E, Cid-Silva P, Rodríguez-Sotelo A, Yáñez-Rubal JC, Mena-de-Cea Á, Suárez-López F, Prieto-Pérez A, Giménez-Arufe V, Delgado-Blanco M, Sanclaudio-Luhia AI, Martín-Herranz I, Castro-Iglesias Á. Effectiveness and safety of direct-acting antivirals in hepatitis C infected patients with mental disorders: Results in real clinical practice. J Med Virol 2020; 92:3488-3498. [PMID: 32181917 DOI: 10.1002/jmv.25772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/10/2020] [Indexed: 11/08/2022]
Abstract
The aim of this study is to analyze the effectiveness and safety of direct-acting antivirals (DAAs) in psychiatric patients with chronic hepatitis C (CHC). Secondary objectives included adherence and drug-drug interaction (DDIs) evaluations. Prospective observational comparative study carried out during 3 years. Psychiatric patients were included and mental illness classified by a psychiatric team based on clinical records. Main effectiveness and safety variables were sustained virologic response (SVR) at posttreatment week 12 (SVR12) and rate of on-treatment serious drug-related adverse events (AEs), respectively. A total of 242 psychiatric and 900 nonpsychiatric patients were included. SVR12 by intention-to-treat (ITT) analysis of psychiatric vs nonpsychiatric patients was 92.6% (95% confidence interval [CI], 89.1-96.1) vs 96.2% (95% CI, 94.9-97.5) (P = .02). SVR12 by modified-ITT analysis was 97.8% (95% CI, 95.0-99.3) vs 98.4% (95% CI, 97.5-99.3) (P = .74). 92.2% of psychiatric patients with mental disorders secondary to multiple drug use (MDSDU) and 93.0% of psychiatric patients without MDSDU vs 96.2% of nonpsychiatric patients reached SVR12 (P = .05 and P = .20, respectively). The percentage of adherent patients to DAAs did not show differences between cohorts (P = .08). 30.2% of psychiatric patients and 27.6% of nonpsychiatric patients presented clinically relevant DDIs (P = .47). 1.7% vs 0.8% of psychiatric vs nonpsychiatric patients developed serious AEs (P = .39); no serious psychiatric AEs were present. DAAs have shown a slightly lower effectiveness in psychiatric patients with CHC, as a result of loss of follow up, which justifies the need for integrated and multidisciplinary health care teams. DAAs safety, adherence, and DDIs, however, are similar to that of nonpsychiatric patients.
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Affiliation(s)
- Luis Margusino-Framiñán
- Pharmacy Service, Universitary Hospital of A Coruña, A Coruña, Spain
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña, SERGAS, University of A Coruña (UDC), A Coruña, Spain
| | | | - Purificación Cid-Silva
- Pharmacy Service, Universitary Hospital of A Coruña, A Coruña, Spain
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña, SERGAS, University of A Coruña (UDC), A Coruña, Spain
| | | | | | - Álvaro Mena-de-Cea
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña, SERGAS, University of A Coruña (UDC), A Coruña, Spain
- Infectious Diseases Unit, Internal Medicine Service, Universitary Hospital of A Coruña, A Coruña, Spain
| | - Francisco Suárez-López
- Hepatology Unit, Digestive System Service, Universitary Hospital of A Coruña, A Coruña, Spain
| | | | | | - Manuel Delgado-Blanco
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña, SERGAS, University of A Coruña (UDC), A Coruña, Spain
- Hepatology Unit, Digestive System Service, Universitary Hospital of A Coruña, A Coruña, Spain
| | | | | | - Ángeles Castro-Iglesias
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña, SERGAS, University of A Coruña (UDC), A Coruña, Spain
- Infectious Diseases Unit, Internal Medicine Service, Universitary Hospital of A Coruña, A Coruña, Spain
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Grassi L, Mezzich JE, Nanni MG, Riba MB, Sabato S, Caruso R. A person-centred approach in medicine to reduce the psychosocial and existential burden of chronic and life-threatening medical illness. Int Rev Psychiatry 2017; 29:377-388. [PMID: 28783462 DOI: 10.1080/09540261.2017.1294558] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The psychiatric, psychosocial, and existential/spiritual pain determined by chronic medical disorders, especially if in advanced stages, have been repeatedly underlined. The right to approach patients as persons, rather than symptoms of organs to be repaired, has also been reported, from Paul Tournier to Karl Jaspers, in opposition and contrast with the technically-enhanced evidence-based domain of sciences that have reduced the patients to 'objects' and weakened the physician's identity deprived of its ethical value of meeting, listening, and treating subjects. The paper will discuss the main psychosocial and existential burden related to chronic and advanced medical illnesses, and the diagnostic and therapeutic implications for a dignity preserving care within a person-centred approach in medicine, examined in terms of care of the person (of the person's whole health), for the person (for the fulfilment of the person's health aspirations), by the person (with physicians extending themselves as total human beings), and with the person (working respectfully with the medically ill person).
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Affiliation(s)
- Luigi Grassi
- a Department of Biomedical and Specialty Surgical Sciences, School of Medicine , Institute of Psychiatry, University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care Integrated Department of Mental Health and Addictive Behavior , University Hospital and Health Authorities , Ferrara , Italy
| | - Juan E Mezzich
- c Icahn School of Medicine at Mount Sinai, International College of Person-Centered Medicine , New York City , NY , USA
| | - Maria Giulia Nanni
- a Department of Biomedical and Specialty Surgical Sciences, School of Medicine , Institute of Psychiatry, University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care Integrated Department of Mental Health and Addictive Behavior , University Hospital and Health Authorities , Ferrara , Italy
| | - Michelle B Riba
- d Integrated Medical and Psychiatric Services Department of Psychiatry , University of Michigan Comprehensive Depression Center , Ann Arbor , MI , USA.,e PsychOncology Program, University of Michigan Comprehensive Cancer Center , Ann Arbor , MI , USA
| | - Silvana Sabato
- a Department of Biomedical and Specialty Surgical Sciences, School of Medicine , Institute of Psychiatry, University of Ferrara , Ferrara , Italy
| | - Rosangela Caruso
- a Department of Biomedical and Specialty Surgical Sciences, School of Medicine , Institute of Psychiatry, University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care Integrated Department of Mental Health and Addictive Behavior , University Hospital and Health Authorities , Ferrara , Italy
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Fialho R, Pereira M, Harrison N, Rusted J, Whale R. Co-infection with HIV associated with reduced vulnerability to symptoms of depression during antiviral treatment for hepatitis C. Psychiatry Res 2017; 253:150-157. [PMID: 28365538 DOI: 10.1016/j.psychres.2017.03.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/03/2017] [Accepted: 03/20/2017] [Indexed: 12/11/2022]
Abstract
In this prospective study, we examined new-onset major depressive disorder (MDD) and the differential expression of depressive symptoms in a sample of 132 HCV mono-infected and 40 HIV/HCV co-infected patients initiating pegylated interferon-based treatment, including protease inhibitor therapy. The semi-structured clinical interview (SCID-I) was used to assess MDD. Severity of depressive symptoms was assessed using the Hamilton Depression Rating Scale. Of the total sample, 60 patients (34.9%) developed SCID-I defined MDD during antiviral treatment. The proportion of HCV mono- and HIV/HCV patients developing MDD during treatment was not significantly different (37.9% vs. 25%; p=0.185). In both groups, there was a significant increase in HAMD total score from baseline to week 4, and a significant decrease between week 24 and 6 months post-treatment cessation. The greatest increase was observed in the symptoms of the neurovegetative syndrome. HCV mono-infected patients reported higher scores than co-infected patients, particularly impaired activity and somatic symptoms, but the differences were only significant at week 12. The finding that co-infected patients appear less vulnerable to the development of depressive symptoms during HCV treatment than HCV mono-infected patients warrants further exploration, including a thorough analysis of the biological and psychosocial factors associated with this emergence.
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Affiliation(s)
- Renata Fialho
- School of Psychology, University of Sussex, Brighton, United Kingdom; Sussex Partnership NHS Foundation Trust, Brighton, United Kingdom.
| | - Marco Pereira
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Neil Harrison
- Clinical Imaging Science Centre, University of Sussex, Brighton, United Kingdom
| | - Jennifer Rusted
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Richard Whale
- Sussex Partnership NHS Foundation Trust, Brighton, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom
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Gonzalez SA, Fierer DS, Talal AH. Medical and Behavioral Approaches to Engage People Who Inject Drugs Into Care for Hepatitis C Virus Infection. ADDICTIVE DISORDERS & THEIR TREATMENT 2017; 16:S1-S23. [PMID: 28701904 PMCID: PMC5491232 DOI: 10.1097/adt.0000000000000104] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Direct-acting antivirals for hepatitis C virus infection may revolutionize treatment among persons with substance use disorders. Despite persons with substance use disorders having the highest hepatitis C virus prevalence and incidence, the vast majority have not engaged into care for the infection. Previously, interferon-based treatments, with substantial side effects and the propensity to exacerbate mental health conditions, were major disincentives to pursuit of care for the infection. Direct-acting antivirals with viral eradication rates of >90%, significantly improved side effect profiles, and shorter treatment duration are dramatic improvements over prior treatment regimens that should promote widespread hepatitis C virus care among persons with substance use disorders. The major unmet need is strategies to promote persons with substance use disorders engagement into care for hepatitis C virus. Although physical integration of treatment for substance use and co-occurring conditions has been widely advocated, it has been difficult to achieve. Telemedicine offers an opportunity for virtual integration of behavioral and medical treatments that could be supplemented by conventional interventions such as hepatitis C virus education, case management, and peer navigation. Furthermore, harm reduction and strategies to reduce viral transmission are important to cease reinfection among persons with substance use disorders. Widespread prescription of therapy for hepatitis C virus infection to substance users will be required to achieve the ultimate goal of global virus elimination. Combinations of medical and behavioral interventions should be used to promote persons with substance use disorders engagement into and adherence with direct-acting antiviral-based treatment approaches. Ultimately, either physical or virtual colocation of hepatitis C virus and substance use treatment has the potential to improve adherence and consequently treatment efficacy.
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Affiliation(s)
- Stevan A. Gonzalez
- Division of Hepatology, Baylor Simmons Transplant Institute, Fort Worth, TX
| | | | - Andrew H. Talal
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine, State University of New York at Buffalo, Buffalo, NY
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Fialho R, Pereira M, Rusted J, Whale R. Depression in HIV and HCV co-infected patients: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2017; 22:1089-1104. [PMID: 28100073 DOI: 10.1080/13548506.2017.1280177] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this study was to carry out a systematic review and meta-analysis of the differences in the prevalence of depression and presence of depressive symptoms between HIV/HCV co-infection, HIV mono-infection, and hepatitis C virus (HCV) mono-infection. A systematic electronic search of bibliographic databases was performed to locate articles published from the earliest available online until December 2014. Outcomes of depression were based on clinical interviews and validated self-reported measures of depression/depressive symptoms. Of the 188 records initially screened, 29 articles were included in the descriptive systematic review and six were included in the meta-analysis. The meta-analytic results indicated that, as measured by self-reported measures of depression, HIV/HCV co-infected patients were significantly more likely to report depressive symptoms than either HIV (SMD = .24, 95% CI: .03-.46, p = .02) or HCV mono-infected (SMD = .55, 95% CI: .17-.94, p = .005) patients. The variability of the results of the reviewed studies, largely dependent on the samples' characteristics and the methods of assessment of depression, suggests that a clear interpretation of how depression outcomes are affected by the presence of HIV/HCV co-infection is still needed. Failing to diagnose depression or to early screen depressive symptoms may have a significant impact on patients' overall functioning and compromise treatments' outcomes.
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Affiliation(s)
- Renata Fialho
- a School of Psychology , University of Sussex , Brighton , UK.,b Sussex Partnership NHS Foundation Trust , Brighton , UK
| | - Marco Pereira
- c Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
| | - Jennifer Rusted
- a School of Psychology , University of Sussex , Brighton , UK
| | - Richard Whale
- b Sussex Partnership NHS Foundation Trust , Brighton , UK.,d Brighton and Sussex Medical School , Brighton , UK
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