1
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Stoenescu AF, Popescu CP, Florescu SA, Vancea G, Ceausu E, Calistru P. The Prevalence of Depression and Its Potential Link to Liver Fibrosis in Patients Diagnosed With Chronic Hepatitis C Virus Infection Prior to the Initiation of Direct-Acting Antiviral Treatment. Cureus 2024; 16:e62970. [PMID: 38912074 PMCID: PMC11194022 DOI: 10.7759/cureus.62970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Chronic hepatitis C virus (HCV) infection is associated with various extrahepatic manifestations, including depression. This study aimed to determine the prevalence of depression in treatment-naive HCV patients and explore its potential association with liver fibrosis severity. Methodology A consecutive cohort of 50 treatment-naive HCV patients without coinfections was enrolled over six months. Depression was assessed using the Hamilton Depression Rating Scale (HAM-D), and the liver fibrosis stage was evaluated using Fibroscan elastography. Results The cohort comprised 62% females (n=31) and 38% males (n=19), with ages ranging from 27 to 76 years. HAM-D scores indicated mild depression in 78% (n=39) and moderate depression in 16% (n=8) of patients. Notably, patients with mild depression displayed varying degrees of liver fibrosis (F0, F1, and F2), while all patients with moderate depression had advanced fibrosis (F3). Based on the multiple regression model, fibrosis was a statistically significant independent predictor with an unstandardized regression coefficient (B) of 3.115 (p=0.007). Conclusions Our findings point to a high prevalence of depression in treatment-naive HCV patients. Interestingly, there might be a link between depression severity and the stage of liver fibrosis, with advanced fibrosis potentially associated with more severe depression.
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Affiliation(s)
- Andreea Florentina Stoenescu
- Infectious Diseases, Carol Davila University of Medicine and Pharmacy, Dr. Victor Babes Hospital of Infectious and Tropical Diseases, Bucharest, ROU
| | - Corneliu Petru Popescu
- Infectious Diseases, Carol Davila University of Medicine and Pharmacy, Dr. Victor Babes Hospital of Infectious and Tropical Diseases, Bucharest, ROU
| | - Simin Aysel Florescu
- Infectious Diseases, Carol Davila University of Medicine and Pharmacy, Dr. Victor Babes Hospital of Infectious and Tropical Diseases, Bucharest, ROU
| | - Geta Vancea
- Infectious Diseases, Carol Davila University of Medicine and Pharmacy, Dr. Victor Babes Hospital of Infectious and Tropical Diseases, Bucharest, ROU
| | - Emanoil Ceausu
- Infectious Diseases, Academy of Medical Sciences, Dr. Victor Babes Hospital of Infectious and Tropical Diseases, Bucharest, ROU
| | - Petre Calistru
- Infectious Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
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2
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Fortini I, Arouca EMG, Tengam FM, Nitrini R. Chronic HCV infection and neuropsychiatric dysfunction. eNeurologicalSci 2019; 17:100206. [PMID: 31656863 PMCID: PMC6806448 DOI: 10.1016/j.ensci.2019.100206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 08/23/2019] [Accepted: 09/03/2019] [Indexed: 02/06/2023] Open
Abstract
•Cognitive impairment may contribute to the morbidity of chronic HCV infection.•Deficits in memory recall can be found in chronic HCV patients.•There is a lack of correlation between virus genotypes, viral load and cognitive performance.•Minimal hepatic encephalopathy may be present in HCV patients with cognitive impairment.
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Affiliation(s)
- Ida Fortini
- Department of Neurology, University of São Paulo School of Medicine, Avenida Dr. Eneas de Carvalho Aguiar 155, Room n° 5140, 5th floor, ZIP code: 05403-000 Cerqueira César, São Paulo, Brazil
| | - Eustáquio Martins Gomes Arouca
- Department of Neurology, University of São Paulo School of Medicine, Avenida Dr. Eneas de Carvalho Aguiar 155, Room n° 5140, 5th floor, ZIP code: 05403-000 Cerqueira César, São Paulo, Brazil
| | - Fatima Mitiko Tengam
- Hepatitis C Outpatient Clinic, Department of Infectious and Parasitic Diseases, University of São Paulo School of Medicine, Avenida Dr. Eneas de Carvalho Aguiar 155, 4th floor, Cerqueira César, ZIP code: 05403-000 São Paulo, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo School of Medicine, Avenida Dr. Eneas de Carvalho Aguiar 155, Room n° 5140, 5th floor, ZIP code: 05403-000 Cerqueira César, São Paulo, Brazil
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3
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Guerreiro-Costa LNF, Araújo-Filho JEO, Marback RF, Jesus-Nunes AP, Morais-DE-Jesus M, Quarantini LC. MENTAL DISORDERS AND QUALITY OF LIFE IN PATIENTS AWAITING LIVER TRANSPLANTATION. ARQUIVOS DE GASTROENTEROLOGIA 2019; 56:339-343. [PMID: 31618394 DOI: 10.1590/s0004-2803.201900000-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 08/14/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Liver transplantation is the main therapeutic alternative for patients with advanced liver disease. These patients have high prevalence of psychiatric comorbidities that may negatively interfere in clinical outcomes and quality of life. It is not clear in the literature whether the different etiologies of hepatic disease have the same prevalence of psychiatric disorders. OBJECTIVE The aim of this study was to investigate whether patients in the liver transplant list showed differences in psychiatric characteristics, medical variables and quality of life among different etiological groups. METHODS This is a cross-sectional study that evaluates quality of life, psychiatric and clinical comorbidities through the application of validated questionnaires and instruments in 248 patients who were on transplant waiting list from 2010 to 2014, assisted in a University Hospital and in a Private Hospital in Salvador/Bahia, Brazil. The patients were evaluated through the Mini International Neuropsychiatric Interview (M.I.N.I. PLUS 5.0) and Medical Outcomes Short-Form Health Survey (SF-36). RESULTS The etiology of the most prevalent liver disease was hepatitis C virus. A prevalence of 50.8% of at least one mental disorder was identified. When alcohol abuse/dependence was excluded, the prevalence was 25.8%. Mental health did not show a statistically significant difference in the diverse etiological groups, but a higher prevalence of psychiatric comorbidities was detected among women and younger than 40 years. No cases of psychotic disorders were detected, possibly by exclusion prior to listing. There was no difference in the quality of life domains in the different liver etiological groups. CONCLUSION A high-prevalence of psychiatric disorders was found among all clinical conditions most associated with indication for liver transplantation. Attention is drawn to the absence of patients with psychotic disorders, which suggests that transplantation may not have been indicated for this group of patients. For these reasons, professionals caring for liver transplant candidates should be highly vigilant for the presence of mental disorders, regardless of the etiology of liver disease. Specialized care is recommended to minimize the early exclusion of patients with no other therapeutic possibilities, as well as care of all people with mental disorders.
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Affiliation(s)
- Lívia N F Guerreiro-Costa
- Universidade Federal da Bahia, Faculdade de Medicina, Programa de Pós-graduação em Medicina e Saúde, Salvador, BA, Brasil
| | | | - Roberta Ferrari Marback
- Universidade Federal da Bahia, Faculdade de Medicina, Programa de Pós-graduação em Medicina e Saúde, Salvador, BA, Brasil
| | - Ana Paula Jesus-Nunes
- Universidade Federal da Bahia, Faculdade de Medicina, Programa de Pós-graduação em Medicina e Saúde, Salvador, BA, Brasil
| | - Mychelle Morais-DE-Jesus
- Universidade Federal da Bahia, Faculdade de Medicina, Programa de Pós-graduação em Medicina e Saúde, Salvador, BA, Brasil
| | - Lucas C Quarantini
- Universidade Federal da Bahia, Faculdade de Medicina, Programa de Pós-graduação em Medicina e Saúde, Salvador, BA, Brasil.,Universidade Federal da Bahia, Faculdade de Medicina, Salvador, BA, Brasil.,Universidade Federal da Bahia, Serviço de Psiquiatria, Com-HUPES, Salvador, BA, Brasil
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4
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Forton D, Weissenborn K, Bondin M, Cacoub P. Expert opinion on managing chronic HCV in patients with neuropsychiatric manifestations. Antivir Ther 2019; 23:47-55. [PMID: 30451150 DOI: 10.3851/imp3245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2018] [Indexed: 10/27/2022]
Abstract
Neurological manifestations of HCV infection appear to be under-recognized in clinical practice despite the majority of HCV-infected patients experiencing symptoms such as fatigue, depression and cognitive dysfunction. There is also growing evidence for a link between HCV infection and an increased risk of Parkinson's disease. The mechanism underpinning the association between HCV and these neuropsychiatric syndromes still requires further investigation. Here we review the pre-clinical and clinical evidence for a link between HCV and effects on the central nervous system leading to neuropsychiatric syndromes. Lastly, we describe how improvements in neuropsychiatric manifestations of HCV following treatment have been observed, which is subsequently reflected in an overall improvement in health-related quality of life.
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Affiliation(s)
- Daniel Forton
- Department of Gastroenterology and Hepatology, St George's Hospital London, London, UK.,St George's University of London, London, UK
| | | | | | - Patrice Cacoub
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France.,INSERM, UMR_S 959, Paris, France.,CNRS, FRE3632, F-75005, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France
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5
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Lakhan P, Askew D, Hayman N, Pokino LA, Sendall C, Clark PJ. Optimising Hepatitis C care in an urban Aboriginal and Torres Strait Islander primary health care clinic. Aust N Z J Public Health 2019; 43:228-235. [PMID: 30908846 DOI: 10.1111/1753-6405.12888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 02/01/2018] [Accepted: 02/01/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Describe the sociodemographic and clinical characteristics of patients with Hepatitis C Virus (HCV) attending an urban Indigenous primary health clinic (IPHC) in Brisbane, Australia. METHODS A retrospective chart review of sociodemographic characteristics, presence of liver disease and treatments, lifestyle behaviours and comorbidities in patients with a HCV infection was conducted between October 2015 and March 2016. RESULTS One hundred and thirteen patients with confirmed HCV infection were aged between seven and 63 years; 66% were male, and 84% were Indigenous. Sixty-nine per cent had been incarcerated; 41% had experienced conflict or domestic violence; 47% were injecting drugs; 72% had depression; and 61% had anxiety. Cirrhosis was present in 7/95 patients with adequate data and associated with age (p=0.02). Eleven patients had commenced direct acting antiviral (DAA) therapy in the 18 months that it had been available. CONCLUSIONS The study highlights the opportunities for enhancing treatment of patients with HCV infection. Opportunities to improve treatment rates in an Indigenous primary healthcare include optimising diagnostic pathways, improving patient engagement, and general practitioner and peer worker participation. Implications for public health: HCV poses a serious threat to public health in Australia and IPHCs are key sites to addressing this for Indigenous people. Optimising care of patients with HCV attending IPHC requires recognition of the complex health needs and social context, to reduce the incidence and consequences of HCV infection.
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Affiliation(s)
- Prabha Lakhan
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Deborah Askew
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland.,The University of Queensland, Primary Care Clinical Unit, Royal Brisbane and Women's Hospital, Queensland
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Leigh-Anne Pokino
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Cheryl Sendall
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Paul J Clark
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland.,Faculty of Medicine, The University of Queensland.,Department of Gastroenterology, The Princess Alexandra and Mater Hospitals, Queensland
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6
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Anagnostopoulos A, Abraham AG, Genberg BL, Kirk GD, Mehta SH. Prescription drug use and misuse in a cohort of people who inject drugs (PWID) in Baltimore. Addict Behav 2018; 81:39-45. [PMID: 29425791 PMCID: PMC5845821 DOI: 10.1016/j.addbeh.2018.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prescription drug misuse and its consequences (e.g., overdose) are a major public health concern. While national focus has been on opioids, misuse of sedatives/tranquilizers also occurs. Here we describe the use, correlates, and sources of prescription drugs in a community-based cohort of people who inject drugs (PWID). METHODS We included participants of the AIDS Linked to the IntraVenous Experience (ALIVE) study in follow-up in 2014. We defined prescription drug use as use of opioids or sedatives/tranquilizers considering both medical "prescribed by a doctor" and non-medical sources "obtained from the street/friend/relative." Correlates were evaluated separately for opioids and sedatives/tranquilizers using logistic regression and included socioeconomic factors, health conditions, substance use, and health care access. RESULTS 823 predominantly African-American (90.6%) and male (66.3%) ALIVE participants with a median age of 55 were included. Prevalence of prescription opioid and sedative/tranquilizer use was 25.3% and 16.3% respectively. While the majority (70%) obtained prescription drugs exclusively through medical sources, the 30% who reported any non-medical source were also more likely to use other substances by injection and non-injection routes. PWID reporting prescription drug use (from medical and non-medical sources) were significantly more likely to report other substance use, mental health disorder, and recent contact with health care providers or detoxification facilities. CONCLUSIONS Prescription drug use was highly prevalent among PWID. While it is difficult to distinguish medically indicated from non-medical use, high levels of prescription drug use in conjunction with other drugs and alcohol heightens the risk for drug overdose and other adverse consequences.
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Affiliation(s)
- Alexia Anagnostopoulos
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore 21205, MD, USA.
| | - Alison G Abraham
- Department of Ophthalmology, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore 21287, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore 21205, MD, USA.
| | - Becky L Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore 21205, MD, USA.
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore 21205, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore 21287, MD, USA.
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore 21205, MD, USA.
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7
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The Impact of Substance Use on Adherence to Antiretroviral Therapy Among HIV-Infected Women in the United States. AIDS Behav 2018; 22:896-908. [PMID: 28560499 DOI: 10.1007/s10461-017-1808-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Research is scant regarding differential effects of specific types of recreational drugs use on antiretroviral therapy adherence among women, particularly to single-tablet regimens (STR). This is increasingly important in the context of marijuana legalization. We examined the effects of self-reported substance use on suboptimal (<95%) adherence in the Women's Interagency HIV Study, 2003-2014. Among 1799 HIV-infected women, the most prevalent substance used was marijuana. In multivariable Poisson GEE regression, substance use overall was significantly associated with suboptimal adherence (adjusted prevalence ratio, aPR = 1.20, 95% CI 1.10-1.32), adjusting for STR use, socio-demographic, behavioral, and clinical factors. Among STR users, compared to no drug use, substance use overall remained detrimental to ART adherence (aPR = 1.61, 95% CI 1.24-2.09); specifically, both marijuana (aPR = 1.48, 95% CI: 1.11-1.97) and other drug use (aPR = 1.87, 95% CI 1.29-2.70) predicted suboptimal adherence. These findings highlight the need to intervene with drug-using women taking antiretroviral therapy to maintain effective adherence.
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8
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Adinolfi LE, Nevola R, Rinaldi L, Romano C, Giordano M. Chronic Hepatitis C Virus Infection and Depression. Clin Liver Dis 2017; 21:517-534. [PMID: 28689590 DOI: 10.1016/j.cld.2017.03.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatitis C virus (HCV) infection is a systemic disease with hepatic and extrahepatic manifestations, including neuropsychiatric conditions. Depression is a frequent disorder, which has been reported in one-third of patients with HCV infection and has an estimated prevalence of 1.5 to 4.0 times higher than that observed in patients with chronic hepatitis B virus infection or the general population. HCV seems to play a direct and indirect role in the development of depression. Impaired quality of life and increasing health care costs have been reported for patients with HCV infection with depression. Treatment-induced HCV clearance has been associated with improvement of depression and quality of life.
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Affiliation(s)
- Luigi Elio Adinolfi
- Department of Medicine, Surgery, Neurology, Metabolism, and Aging Sciences, University of Study of Campania "Luigi Vanvitelli", Piazza Miraglia, Naples 80100, Italy.
| | - Riccardo Nevola
- Department of Medicine, Surgery, Neurology, Metabolism, and Aging Sciences, University of Study of Campania "Luigi Vanvitelli", Piazza Miraglia, Naples 80100, Italy
| | - Luca Rinaldi
- Department of Medicine, Surgery, Neurology, Metabolism, and Aging Sciences, University of Study of Campania "Luigi Vanvitelli", Piazza Miraglia, Naples 80100, Italy
| | - Ciro Romano
- Department of Medicine, Surgery, Neurology, Metabolism, and Aging Sciences, University of Study of Campania "Luigi Vanvitelli", Piazza Miraglia, Naples 80100, Italy
| | - Mauro Giordano
- Department of Medicine, Surgery, Neurology, Metabolism, and Aging Sciences, University of Study of Campania "Luigi Vanvitelli", Piazza Miraglia, Naples 80100, Italy
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9
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Yarlott L, Heald E, Forton D. Hepatitis C virus infection, and neurological and psychiatric disorders - A review. J Adv Res 2016; 8:139-148. [PMID: 28149649 PMCID: PMC5272938 DOI: 10.1016/j.jare.2016.09.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/09/2016] [Accepted: 09/09/2016] [Indexed: 02/06/2023] Open
Abstract
An association between hepatitis C virus infection and neuropsychiatric symptoms has been proposed for some years. A variety of studies have been undertaken to assess the nature and severity of these symptoms, which range from fatigue and depression to defects in attention and verbal reasoning. There is evidence of mild neurocognitive impairment in some patients with HCV infection, which is not fully attributable to liver dysfunction or psychosocial factors. Further evidence of a biological cerebral effect has arisen from studies using magnetic resonance spectroscopy; metabolic abnormalities correlate with cognitive dysfunction and resemble the patterns of neuroinflammation that have been described in HIV infection. Recent research has suggested that, in common with HIV infection, HCV may cross the blood brain barrier leading to neuroinflammation. Brain microvascular endothelial cells, astrocytes and microglia may be minor replication sites for HCV. Importantly, patient reported outcomes improve following successful antiviral therapy. Further research is required to elucidate the molecular basis for HCV entry and replication in the brain, and to clarify implications and recommendations for treatment.
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Affiliation(s)
- Lydia Yarlott
- Department of Gastroenterology and Hepatology, St George's University Hospitals NHS Foundation Trust, Blackshaw Rd, London SW17 0QT, United Kingdom
| | - Eleanor Heald
- Department of Gastroenterology and Hepatology, St George's University Hospitals NHS Foundation Trust, Blackshaw Rd, London SW17 0QT, United Kingdom
| | - Daniel Forton
- Department of Gastroenterology and Hepatology, St George's University Hospitals NHS Foundation Trust, Blackshaw Rd, London SW17 0QT, United Kingdom; St George's, University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
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10
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Chereji E, Kern S, Fuller B, Morasco BJ, Phelps A, Hauser P. Co-occurring Depression, Chronic Pain and Substance Use Disorders in People with Hepatitis C. ACTA ACUST UNITED AC 2016. [DOI: 10.2174/1874220301603010079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic infection with Hepatitis C virus (HCV) is common and can result in serious and sometimes fatal liver complications. The impact of HCV on the liver can be further complicated by medical and psychological comorbidities. Depression, substance use, and pain syndromes are frequent co-morbid conditions in people with HCV and diminish functioning, quality of life, and treatment compliance. Understanding the underlying biological mechanisms of these comorbid conditions within the context of HCV may help elucidate factors contributing to their co-occurrence, perhaps mediatedviapro-inflammatory cytokines. The current review provides a synthesis of the literature on depression, substance use disorders and chronic pain in the presence of HCV. The review includes studies conducted with both veteran and civilian populations. The implications for assessment and antiviral treatment of HCV will be considered.
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11
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Rogers MR, Lemstra ME, Moraros JS. Risk Indicators of Depressed Mood Among Sex-Trade Workers and Implications for HIV Risk Behaviour. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:548-55. [PMID: 26720823 PMCID: PMC4679163 DOI: 10.1177/070674371506001205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 03/01/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the prevalence of depressed mood among people who have traded sex for money in the Saskatoon Health Region (SHR), the adjusted risk factors for depressed mood among this sample, and if depressed mood was associated with decreased self-efficacy for safe sexual practices and injection drug use. METHODS Two-hundred ninety-nine people who have traded sex for money were surveyed with validated instruments for measuring risk behaviours, depressed mood, and self-efficacy for safe sexual practices. RESULTS The sample consisted primarily of low-income, poorly educated Aboriginal women, many of whom also indicated using injection drugs. Using the 16-point score cut-off for the Center for Epidemiologic Studies Depression Scale, 84.6% of participants had depressed mood. When the cut-off score was 23 points or higher, 65.9% had depressed mood. After multivariate analysis, covariates that had an independent association with depressed mood included injecting a drug in the past 4 weeks (OR 1.59; 95% CI 1.2 to 1.8), suffering the death or permanent separation from a parent before the age of 18 (OR 2.09; 95% CI 1.05 to 4.15), and physical assault or abuse by a partner in adult life (OR 2.79; 95% CI 1.38 to 5.64). Depressed mood was associated with lower self-efficacy scores for safe sexual behaviours. CONCLUSIONS Our study suggests that high rates of depressed mood among people who have traded sex for money is associated with injection drug use and low self-efficacy for safe sexual health practices. These findings are important and may help explain the high rates of human immunodeficiency virus within the SHR.
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Affiliation(s)
- Marla Rochelle Rogers
- Research Study Coordinator, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Mark Edgar Lemstra
- Adjunct Professor, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - John Simeon Moraros
- Assistant Professor, School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan
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12
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Hilgenfeldt EG, Schlachterman A, Firpi RJ. Hepatitis C: Treatment of difficult to treat patients. World J Hepatol 2015; 7:1953-63. [PMID: 26244069 PMCID: PMC4517154 DOI: 10.4254/wjh.v7.i15.1953] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 05/29/2015] [Accepted: 07/16/2015] [Indexed: 02/06/2023] Open
Abstract
Over the past several years, more so recently, treatment options for hepatitis C virus (HCV) have seemed to exponentially grow. Up until recently, the regimen of pegylated interferon (peg-IFN) and ribavirin (RBV) stood as the standard of care. Direct acting antivirals, which target nonstructural proteins involved in replication and infection of HCV were first approved in 2011 as an addition to the peg-IFN and RBV regimen and with them have come increased sustained virological response rates (SVR). The previously reported 50%-70% SVR rates using the combination of peg-IFN and RBV are no longer the standard of care with direct acting antiviral (DAA) based regimens now achieving SVR of 70%-90%. Peg-IFN free as well as "all oral" regimens are also available. The current randomized controlled trials available show favorable SVRs in patients who are naive to treatment, non-cirrhotic, and not human immunodeficiency virus (HIV)-co-infected. What about patients who do not fit into these categories? In this review, we aim to discuss the currently approved and soon to be approved DAAs while focusing on their roles in patients that are treatment experienced, cirrhotic, or co-infected with HIV. In this discussion, review of the clinical trials leading to recent consensus guidelines as well as discussion of barriers to treatment will occur. A case will attempt will be made that social services, including financial support and drug/alcohol treatment, should be provided to all HCV infected patients to improve chances of cure and thus prevention of late stage sequela.
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Affiliation(s)
- Eric G Hilgenfeldt
- Eric G Hilgenfeldt, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | - Alex Schlachterman
- Eric G Hilgenfeldt, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | - Roberto J Firpi
- Eric G Hilgenfeldt, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States
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13
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A Preliminary Study on the Relationship between Platelet Serotonin Transporter Functionality, Depression, and Fatigue in Patients with Untreated Chronic Hepatitis C. DEPRESSION RESEARCH AND TREATMENT 2014; 2014:821381. [PMID: 24778869 PMCID: PMC3978905 DOI: 10.1155/2014/821381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 01/07/2014] [Accepted: 01/23/2014] [Indexed: 02/06/2023]
Abstract
Objective and Methods. Although the interaction between fatigue and depression in patients with chronic hepatitis C infection (HCV) has been recognized, the biological correlates of this observation have yet to be reported. We addressed this issue by examining serotonin transporter- (SERT-) driven [(14)C]-serotonin uptake rate (SUR) and serotonin content in platelets of 65 untreated HCV patients and 65 healthy control subjects (HCS). All patients completed report questionnaires for fatigue, depression, and general psychopathology. Structured interviews were conducted by a board-certified psychiatrist. Results. Whereas 36 of the patients experienced fatigue of moderate-to-severe intensity, only 16 reported symptoms of depression (BDI score > 10). Mean SUR in patients with depressive symptoms was significantly higher relative to the HCS, corresponding to a large Cohen's effect size of d = 1.45 (95% CI = 0.66-1.83). Patients who rated their fatigue to have a marked impact on mood and activity displayed a moderate relationship between the BDI score and SUR (n = 18, r = 0.563, P = 0.015), which becomes stronger after controlling for age, gender, and thrombocytopenia (r part = 0.710, P = 0.003). In the univariate analysis, high fatigue interference score, thrombocytopenia, and high SUR were all significant predictors of depression. Conclusions. High SERT activity could be implicated in the expression of depressive symptoms especially in a subgroup of HCV patients who are feeling fatigue as markedly distressing.
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14
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Marinho RT, Barreira DP. Hepatitis C, stigma and cure. World J Gastroenterol 2013; 19:6703-6709. [PMID: 24187444 PMCID: PMC3812468 DOI: 10.3748/wjg.v19.i40.6703] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 07/28/2013] [Accepted: 08/20/2013] [Indexed: 02/06/2023] Open
Abstract
The infection with hepatitis C virus (HCV) is one of the most important global chronic viral infections worldwide. It is estimated to affect around 3% of the world population, about 170-200 million people. Great part of the infections are asymptomatic, the patient can be a chronic carrier for decades without knowing it. The most severe consequences of the chronic infection are liver cirrhosis and hepatocellular carcinoma, which appears in 20%-40% of the patients, leading to hepatic failure and death. The HCV was discovered 25 years ago in 1989, is a RNA virus and classified by the World Health Organization as an oncogenic one. Hepatocellular carcinoma is one of the most important cancers, the fifth worldwide in terms of mortality. It has been increasing in the Ocidental world, mainly due to chronic hepatitis C. Hepatitis C is not only a liver disease and a cause of cirrhosis, but also a mental, psychological, familiar, and social disease. The stigma that the infected person sometimes carries is tremendous having multiple consequences. The main cause is lack of adequate information, even in the health professionals setting. But, besides the “drama” of being infected, health professionals, family, society and the infected patients, must be aware of the chance of real cure and total and definitive elimination of the virus. The treatment for hepatitis C has begun in the last 80´s with a percentage of cure of 6%. Step by step the efficacy of the therapy for hepatitis C is rapidly increasing and nowadays with the very new medications, the so called Direct Antiviral Agents-DAAs of new generation, is around 80%-90%.
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AlHuthail YR. Comparison of the prevalence of psychiatric co-morbidities in hepatitis C patients and hepatitis B patients in Saudi Arabia. Saudi J Gastroenterol 2013; 19:165-71. [PMID: 23828746 PMCID: PMC3745658 DOI: 10.4103/1319-3767.114514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 04/11/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/AIM Hepatitis C is a major health concern world-wide and is frequently associated with psychiatric co-morbidity. The most common genotype in Saudi Arabia differs from genotypes prevalent elsewhere and thus we aimed to determine if psychiatric disturbances occur in Saudi patients infected with hepatitis C and whether these symptoms extend to those infected with hepatitis B. MATERIALS AND METHODS Data were collected from hepatitis C and hepatitis B patients using the general health questionnaire (GHQ-28) and The Short Form Health Survey (SF-36) questionnaires. Tinnitus patients served as control subjects. The Chi-square test was used to examine the relationship between categorical variables. Continuous variables were compared using the Student's t-test or the Wilcoxon-Mann-Whitney test for skewed data, and correlations were evaluated by calculating Spearman's rho. The odds ratio was used to determine the association between variables and the likelihood of being a psychiatric case. RESULTS Hepatitis C patients were twice as likely to be labeled as a psychiatric case compared with hepatitis B patients ( P = 0.01). Age and gender were not predictive factors though there was a non-significant tendency toward a higher prevalence of psychiatric cases among females. Hepatitis C patients also scored lower than hepatitis B patients in 3 domains of the SF-36 questionnaire, indicating a greater reduction in quality of life (QoL). CONCLUSION We demonstrate an increased incidence of psychiatric symptoms in Saudi Arabian hepatitis C patients compared to hepatitis B patients and controls. This highlights the importance of collaboration between hepatologists and psychiatrists in order to improve the QoL in this patient group.
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Affiliation(s)
- Yaser R AlHuthail
- Department of Psychiatry, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
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Carta MG, Angst J, Moro MF, Mura G, Hardoy MC, Balestrieri C, Chessa L, Serra G, Lai ME, Farci P. Association of chronic hepatitis C with recurrent brief depression. J Affect Disord 2012; 141:361-6. [PMID: 22609196 DOI: 10.1016/j.jad.2012.03.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 03/12/2012] [Accepted: 03/12/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Depressive syndromes, including recurrent brief depression (RBD), have frequently been observed in association with chronic diseases characterized by immune activation, such as autoimmune thyroiditis or celiac disease. However, the association of RBD with chronic hepatitis C (CHC), a disease with an increased incidence of major depressive disorders, is unknown. CASES 135 (83 males, 52 females) consecutive treatment-naïve patients with CHC. EXCLUSION CRITERIA previous treatment with IFN-alpha, co-infection with hepatitis C virus (HCV) and hepatitis B virus, infection with human immunodeficiency virus (HIV), drug or alcohol abuse, or malignancy. CONTROLS 540 (332 males, 208 females) subjects without evidence of hepatitis, randomly extracted from the database of a previous epidemiological study. The psychiatric diagnosis was based on the Composite International Diagnostic Interview Simplified (CIDI-S), containing a specific section on RBD. RESULTS A significantly higher rate of RBD was observed among both male and female patients with CHC (n=21, 15.5%) as compared to controls (n=34, 6.3%) (OR=2.6, CI 95% from 1.37 to 4.93). CONCLUSION The present study provides the first evidence of an association between CHC and RBD, independent of treatment with IFN-alpha and not influenced by substance or alcohol abuse. The results are similar to those found in other conditions with immune activation. RBD may be another expression of mood disorders in such conditions.
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Affiliation(s)
- Mauro G Carta
- Department of Public Health, University of Cagliari, Italy.
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Amodio P, Salari L, Montagnese S, Schiff S, Neri D, Bianco T, Minazzato L. Hepatitis C virus infection and health-related quality of life. World J Gastroenterol 2012; 18:2295-9. [PMID: 22654420 PMCID: PMC3353363 DOI: 10.3748/wjg.v18.i19.2295] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 01/14/2012] [Accepted: 02/08/2012] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) hepatitis and other diseases related to HCV, such as cryoglobulinemia, lymphoma and renal failure, impair health-related quality of life (HRQoL). In addition, HCV per se might directly influence HRQoL via colonization of microglia in the brain or, indirectly, via the effect of systemic inflammatory cytokines which, in turn, can trigger brain interleukin production. The treatment of HCV-related disorders with interferon (IFN) has an effect on HRQoL. Initially, IFN causes a transient deterioration of HRQoL, due to the induction of depression and other side effects of treatment. Subsequently, the subjects who obtain a sustained virologic response experience an improvement in HRQoL. Only rarely does interferon treatment causes permanent detrimental effects on HRQoL, due to residual psychiatric or neurologic side effects. Liver transplantation is the only treatment for end-stage HCV-related liver disease. HRQoL generally improves massively a few months after transplantation, except in the case of serious complications of the transplant procedure. Furthermore, high levels of anxiety and neuroticism pre-transplant are associated with lower HRQoL one year after transplant. Additionally, six months after transplant, patients with HCV who experience virologic recurrence show significantly greater depression, anxiety, phobic anxiety, and paranoid ideation than anti-HCV-negative patients. In conclusion, optimal care for the overall well-being of patients with HCV infection requires adequate knowledge of their neurological and psychological status.
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Depressive and anxiety disorders in chronic hepatitis C patients: reliability and validity of the Patient Health Questionnaire. J Affect Disord 2012; 138:343-51. [PMID: 22326842 DOI: 10.1016/j.jad.2012.01.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 01/10/2012] [Accepted: 01/11/2012] [Indexed: 12/24/2022]
Abstract
UNLABELLED Depression and anxiety in patients with hepatitis C virus (HCV) infection influence their health-related quality of life and their adherence to antiviral treatment. OBJECTIVE To study the psychometric properties of the Patient Health Questionnaire (PHQ) as a screening instrument for depression and anxiety in HCV patients. METHODS Criterion validity, using the structured clinical interview for DSM-IV-Axis I (SCID-I) to diagnose depression and anxiety disorders as diagnostic standard, was evaluated for both summed and algorithm-based PHQ in 500 HCV patients. Correlations with quality of life (Short-Form-36 Health Survey; SF-36) and severity of illness (Hospital Anxiety and Depression Scale; HADS) were calculated to assess construct validity. Test-retest reliability and patients' reaction to the PHQ were assessed in 120 HCV patients. RESULTS Twenty-three percent of patients (N=114) had a psychiatric disorder (any depressive disorder=18.2%; major depressive disorder=6.4%; generalized anxiety disorder=7.0% and panic disorder=5.8%). The questionnaire demonstrated good test-retest reliability for any depressive disorder (k=.847), major depressive disorder (k=.784), generalized anxiety disorder (k=.787), panic disorder (k=.848), and for any psychiatric disorder (k=.847). There was good agreement between PHQ and SCID-I diagnoses (for any PHQ disorder, k=.821; overall accuracy=90.43%, sensitivity=83.84%; specificity=97.01%). Patients with any PHQ disorder had higher impairment on the SF-36 (p<.001). HADS depression and anxiety scores showed high correlations with PHQ depression (p<.001) and anxiety (p<.001) scores respectively. PHQ administration was well accepted by 97% of patients. CONCLUSIONS The Spanish version of the PHQ is a reliable, valid, and useful screening instrument to detect depression, generalized anxiety and panic disorders in HCV patients.
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Johnson ME, Brems C, Wells RS, Theno SA, Fisher DG. Comorbidity and Risk Behaviors Among Drug Users Not in Treatment. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2011. [DOI: 10.1002/j.2161-1874.2003.tb00175.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Yang C, German D, Webster D, Latkin C. Experiencing violence as a predictor of drug use relapse among former drug users in Baltimore, Maryland. J Urban Health 2011; 88:1044-51. [PMID: 21877254 PMCID: PMC3232408 DOI: 10.1007/s11524-011-9610-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of this study was to examine experiencing violence as a predictor of subsequent drug relapse among a sample of former crack, cocaine, and heroin users in Baltimore, MD, USA. The sample consists of 228 former drug users in Baltimore who were recruited through street outreach. Mixed-effects models were used to examine experiencing violence as a predictor of drug relapse at follow-up after adjusting for clustering of responses among participants living in the same census block. Using longitudinal data, we found that experiencing violence in the past year predicted drug relapse at 2-year follow-up among former drug users. Results indicate experiencing violence is a determinant of drug use relapse and highlight the importance of addressing the fundamental issues of violence experienced in inner-city communities. Addressing the extent of recent violence among drug treatment participants, providing coping skills, and reducing community violence are strategies that may address the link between violence and drug relapse.
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Affiliation(s)
- Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Yoon JC, Crane PK, Ciechanowski PS, Harrington RD, Kitahata MM, Crane HM. Somatic symptoms and the association between hepatitis C infection and depression in HIV-infected patients. AIDS Care 2011; 23:1208-18. [PMID: 21562994 PMCID: PMC3534977 DOI: 10.1080/09540121.2011.555739] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Studies of depression and hepatitis C virus (HCV) infection in HIV-infected patients have been contradictory and often not addressed key differences between HCV-infected and uninfected individuals including substance use. This cross-sectional observational study from the University of Washington HIV cohort examined associations between HCV, symptoms, and depression in HIV-infected patients in routine clinical care. Patients completed instruments measuring depression, symptoms, and substance use. We generated depression severity scores and used linear regression to examine the relationship with HCV accounting for demographic and clinical characteristics. We conducted sensitivity analyses in which we removed depression somatic symptom items (e.g., fatigue) from depression scores, and sensitivity analyses in which we also adjusted for nondepression somatic symptom items to examine the role of somatic and nonsomatic symptoms in the association between depression and HCV. Of 764 HIV-infected patients, 160 (21%) were HCV-infected. In adjusted analysis, HCV-infected patients had worse depression severity (p =0.01) even after adjusting for differences in substance use. HCV remained associated with depression severity in secondary analyses that omitted the depression somatic patient health questionnaire-9 (PHQ-9) items (p=0.01). However, when nondepression somatic symptoms were included as covariates in multivariate analyses, HCV was no longer associated with depression (p=0.09).
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Affiliation(s)
- Jeanie C Yoon
- Department of Medicine, University of Washington, Seattle, USA
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Lemstra M, Rogers M, Thompson A, Moraros J, Buckingham R. Risk indicators of depressive symptomatology among injection drug users and increased HIV risk behaviour. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:358-66. [PMID: 21756450 DOI: 10.1177/070674371105600607] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In 2009, the annual incidence of positive human immunodeficiency virus (HIV) test reports for people in the Saskatoon Health Region (SHR) was 31.3 per 100,000, when the national average was only 9.3 per 100 000. The first objective was to determine the prevalence of depressive symptomatology among injection drug users (IDUs) in the SHR. The second objective was to determine the unadjusted and adjusted risk indicators associated with depressive symptomatology among IDUs. The third objective was to determine if depressive symptomatology was associated with HIV risk behaviours. METHODS From September 2009 to April 2010, 603 current IDUs were surveyed with validated instruments; this sample represents 76.6% of known IDUs in the SHR. RESULTS Among the respondents, 81.4% reported depressive symptomatology, whereas 57.7% reported more severe depressive symptomatology. After multivariate analysis, the 4 covariates that had an independent association with depressive symptomatology included sexual assault as an adult, sexual assault as a child, attending a residential school, and having an annual income of less than $10,000 Depressive symptomatology was initially associated with 7 HIV risk behaviours. After multivariate analysis, depressive symptomatology was associated with giving sex to get money, giving drugs to get sex, and with more frequently sharing injecting equipment. CONCLUSIONS This study found that depressive symptomatology was strongly associated with injection drug use.
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Affiliation(s)
- Mark Lemstra
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan.
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Smith KJ, Norris S, O'Farrelly C, O'Mara SM. Risk factors for the development of depression in patients with hepatitis C taking interferon-α. Neuropsychiatr Dis Treat 2011; 7:275-92. [PMID: 21654873 PMCID: PMC3101888 DOI: 10.2147/ndt.s13917] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Indexed: 12/28/2022] Open
Abstract
Interferon-α, currently used for the treatment of hepatitis C, is associated with a substantially elevated risk of depression. However, not everyone who takes this drug becomes depressed, so it is important to understand what particular factors may make some individuals more 'at risk' of developing depression than others. Currently there is no consensus as to why interferon-induced depression occurs and the range of putative risk factors is wide and diverse. The identification of risk factors prior to treatment may allow identification of patients who will become depressed on interferon, allowing the possibility of improved treatment support and rates of treatment adherence. Here, we consolidate and review the literature on risk factors, and we discuss the potential confounds within the research examined in order to better isolate the risk factors that may be important in the development of depression in these patients and which might help predict patients likely to become depressed on treatment. We suggest that interactions between psychobehavioral, genetic, and biological risk factors are of particular importance in the occurrence of depression in patients with hepatitis C taking interferon-α.
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Sockalingam S, Shammi C, Powell V, Barker L, Remington G. Determining rates of hepatitis C in a clozapine treated cohort. Schizophr Res 2010; 124:86-90. [PMID: 20605572 DOI: 10.1016/j.schres.2010.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 06/02/2010] [Accepted: 06/07/2010] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the prevalence rates of hepatitis C in patients with schizophrenia and schizoaffective disorder being treated with clozapine. METHODS Clozapine-treated outpatients and inpatients were recruited from the Centre for Addiction and Mental Health Schizophrenia Program in Toronto, Canada. All subjects had liver function tests, and positive HCV status was defined as a positive qualitative HCV RNA assay. Subjects completed a self-report questionnaire assessing HCV risk factors, past history of liver disease, previous diagnosis of human immunodeficiency virus (HIV), past hepatitis B virus (HBV) infection and current alcohol use. RESULTS 110 subjects participated in the study and the HCV prevalence rate (antibody and viremia-positive) was 2.7%, compared to a 0.8% prevalence rate in Canada. All study subjects had established housing, none reported a history of HIV, and only one patient had a history of HBV infection. A total of 9% drank two or more drinks on a typical day drinking and 7% endorsed having six or more drinks on one occasion at least monthly. Two of 3HCV-viremia positive subjects had HCV risk factors, specifically intravenous drug use and intranasal cocaine use. There was no difference between HCV infected and HCV negative subjects on liver function tests. CONCLUSIONS Our study demonstrates elevated rates of HCV in clozapine-treated patients compared to the general population in Canada and are congruent with reports from United States centres. Our study highlights the importance of homelessness and patterns of high-risk behaviour when interpreting HCV prevalence rates in this sub-population of patients and should be explored in future studies.
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Affiliation(s)
- Sanjeev Sockalingam
- Psychiatry, Health and Disease Division, University Health Network, Toronto, Ontario, Canada.
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Wilson MP, Castillo EM, Batey AM, Sapyta J, Aronson S. Hepatitis C and depressive symptoms: psychological and social factors matter more than liver injury. Int J Psychiatry Med 2010; 40:199-215. [PMID: 20848876 DOI: 10.2190/pm.40.2.f] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Given that the hepatitis C virus (HCV) crosses the blood-brain barrier, biological factors are commonly blamed for the high rates of mood disturbance in HCV-infected patients. However, no study assessing the potential contribution of psychosocial factors to depression in HCV has yet been conducted. METHODS A cross-sectional survey of 65 patients was undertaken to identify biological, psychological, and sociological contributions to depression. Biological, psychological, and sociological variables were tested for their association with depressive symptomatology as measured by the BDI-II. Separate analyses were conducted on health-related quality of life (HRQOL), as measured by the SF-36, in order to confirm findings in previous work. RESULTS Psychosocial variables assessed in the study, such as less social functioning, less religious faith, less ability to work, less salary, personal suicide attempt, worse reaction to diagnosis, and feeling "stressed out" were all associated with higher depression scores and lower HRQOL. Biological variables, including viral load, liver enzyme levels, INR, and stage of liver fibrosis on biopsy, were not associated with higher depression or lower HRQOL. CONCLUSIONS The amount of disease as measured by laboratory abnormalities such as viral load, liver function tests, liver biopsy, and INR do not provide much useful information about a patient's depressive symptoms. Instead, these depressive symptoms are more influenced by psychological and social factors. Psychosocial support may therefore be beneficial to HCV patients.
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Affiliation(s)
- Michael P Wilson
- Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, CA 92103-8819, USA.
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Drummond MB, Kirk GD, Ricketts EP, McCormack MC, Hague JC, McDyer JF, Mehta SH, Engels EA, Wise RA, Merlo CA. Cross sectional analysis of respiratory symptoms in an injection drug user cohort: the impact of obstructive lung disease and HIV. BMC Pulm Med 2010; 10:27. [PMID: 20459792 PMCID: PMC2876103 DOI: 10.1186/1471-2466-10-27] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 05/11/2010] [Indexed: 02/06/2023] Open
Abstract
Background Injection drug use is associated with an increased risk of human immunodeficiency virus (HIV) infection and with obstructive lung diseases (OLD). Understanding how HIV and OLD may impact respiratory symptoms among injection drug users (IDUs) is important to adequately care for this high-risk population. We characterized the independent and joint effects of HIV and OLD on respiratory symptoms of a cohort of inner-city IDUs. Methods Demographics, risk behavior and spirometric measurements were collected from a cross-sectional analysis of the Acquired Immunodeficiency Syndrome Link to the IntraVenous Experience study, an observational cohort of IDUs followed in Baltimore, MD since 1988. Participants completed a modified American Thoracic Society respiratory questionnaire and the Medical Research Council (MRC) dyspnea score to assess respiratory symptoms of cough, phlegm, wheezing and dyspnea. Results Of 974 participants, 835 (86%) were current smokers and 288 (29.6%) were HIV-infected. The prevalence of OLD (FEV1/FVC ≤ 0.70) was 15.5%, and did not differ by HIV status. OLD, but not HIV, was associated with increased frequency of reported respiratory symptoms. There was a combined effect of OLD and HIV on worsening of MRC scores. OLD and HIV were independently associated with an increased odds of reporting an MRC ≥ 2 (OR 1.83 [95%CI 1.23-2.73] and 1.50 [95%CI 1.08-2.09], respectively). COPD, but not HIV, was independently associated with reporting an MRC ≥ 3 (OR 2.25 [95%CI 1.43-3.54] and 1.29 [95%CI 0.87-1.91], respectively). Conclusions While HIV does not worsen cough, phlegm or wheezing, HIV significantly increases moderate but not severe dyspnea in individuals of similar OLD status. Incorporating the MRC score into routine evaluation of IDUs at risk for OLD and HIV provides better assessment than cough, phlegm and wheezing alone.
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Affiliation(s)
- M Bradley Drummond
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Erim Y, Tagay S, Beckmann M, Bein S, Cicinnati V, Beckebaum S, Senf W, Schlaak JF. Depression and protective factors of mental health in people with hepatitis C: A questionnaire survey. Int J Nurs Stud 2010; 47:342-9. [DOI: 10.1016/j.ijnurstu.2009.08.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Revised: 07/24/2009] [Accepted: 08/13/2009] [Indexed: 02/06/2023]
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Sockalingam S, Abbey SE. Managing depression during hepatitis C treatment. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2009; 54:614-25. [PMID: 19751550 DOI: 10.1177/070674370905400906] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The prevalence of hepatitis C virus (HCV) infection in Canada is estimated to be 1% and expected to increase during the next decade. Mental illness, particularly depression, is common among HCV-infected patients and remains an obstacle to interferon-alpha (IFN-alpha) treatment. We summarize the risk factors for interferon-alpha-induced major depressive disorder (IFN-alpha-MDD) in HCV patients and the evidence for antidepressant prophylaxis and symptomatic antidepressant treatment of depression. METHODS We searched MEDLINE, EMBASE, and CINAHL for randomized controlled or quasi-experimental trials evaluating antidepressant prophylactic and symptomatic treatment approaches for depression emerging during IFN-alpha treatment. Manual searches of references listed in review articles, case series, and anecdotal reports supplemented our literature search. RESULTS A total of 9 trials involving prophylactic and symptomatic treatment approaches for IFN-alpha-MDD are summarized in our review. Antidepressant pretreatment is beneficial for patients with elevated baseline depressive symptoms and a preexisting history of IFN-alpha-MDD. Although limited evidence exists for several antidepressant agents, much of the evidence suggests that selective serotonin reuptake inhibitors (SSRIs) are safe and efficacious in treating depressive symptoms secondary to IFN-alpha therapy. CONCLUSION Both antidepressant pretreatment and symptomatic treatment are viable strategies for treating IFN-alpha-MDD. Improved treatment outcomes and early identification of depression during HCV treatment can be achieved using an integrated medical and mental health treatment approach.
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Affiliation(s)
- Sanjeev Sockalingam
- Program in Medical Psychiatry, Toronto General Hospital, University Health Network, Toronto, Ontario.
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Health Services Usage by Alaskan Injection Drug Users. J Ethn Subst Abuse 2008. [DOI: 10.1300/j233v03n04_05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abdo AA. Hepatitis C and poor quality of life: is it the virus or the patient? Saudi J Gastroenterol 2008; 14:109-13. [PMID: 19568517 PMCID: PMC2702919 DOI: 10.4103/1319-3767.41727] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 06/10/2008] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C is a systemic disease that has many extrahepatic manifestations in addition to hepatic inflammation and fibrosis, some of which may result in a poor health-related quality of life (HRQOL). Fatigue is perhaps the most frequent and disabling extrahepatic symptom of hepatitis C virus (HCV), reported in almost one-half of all chronically infected individuals. Many other factors are associated with a poor quality of life in patients with HCV, including a number of physical and psychological factors. The objective of this article is to review the association between HCV and impaired HRQOL due to fatigue and psychological disturbances.
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Affiliation(s)
- Ayman A Abdo
- Division of Gastroenterology, Department of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Dbouk N, Arguedas MR, Sheikh A. Assessment of the PHQ-9 as a screening tool for depression in patients with chronic hepatitis C. Dig Dis Sci 2008; 53:1100-6. [PMID: 17934817 DOI: 10.1007/s10620-007-9985-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Accepted: 08/15/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES We examined the test characteristics of the PHQ-9, a new screening tool that has been validated in the general population but not amongst patients with hepatitis C virus (HCV). METHODS The PHQ-9, CES-D and BDI-II questionnaires were administered to 129 consecutive patients with chronic HCV attending a specialty clinic between August 2005 and April 2006. RESULTS Approximately 52% of participants reported symptoms suggesting depression. Prevalence of depression was 62% using the BDI-II, 75% per the PHQ-9 and 72% per the CES-D. We observed a strong correlation between the BDI-II, CES-D and PHQ-9 in patients on and off interferon. Scores on the three questionnaires were only moderately associated with symptoms reported by the patients. There was moderate agreement between the CES-D and BDI-II and slight agreement between both these questionnaires and the PHQ-9. Scores on the PHQ-9 correlated strongly with scores on the CES-D and BDI-II and moderately with patients' symptoms.
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Affiliation(s)
- Nader Dbouk
- Department of Internal Medicine, The University of Alabama at Birmingham, 1530 3rd Avenue South BDB 327, Birmingham, AL 35294, USA.
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High frequency of unrecognized mental disorders in HCV-infected patients. Gen Hosp Psychiatry 2008; 30:80-2. [PMID: 18164946 DOI: 10.1016/j.genhosppsych.2007.08.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Revised: 08/22/2007] [Accepted: 08/24/2007] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study indexed the frequency of psychiatric disorders among hepatitis C virus (HCV)-infected patients. METHOD HCV-infected patients treated at a university hospital in the northeastern region of Brazil were evaluated in a cross-sectional study using the Mini International Neuropsychiatric Interview. RESULTS Ninety HCV-infected outpatients were included in the study and 44 (49%) had at least one psychiatric diagnosis. Among the 26 patients (59.1%) with a current psychiatric morbidity, 22 (84.6%) had gone undiagnosed. CONCLUSIONS HCV-infected patients have a high frequency of unrecognized psychiatric comorbidity.
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Thein H, Maruff P, Krahn M, Kaldor J, Koorey D, Brew B, Dore G. Cognitive function, mood and health-related quality of life in hepatitis C virus (HCV)-monoinfected and HIV/HCV-coinfected individuals commencing HCV treatment. HIV Med 2007; 8:192-202. [PMID: 17461864 DOI: 10.1111/j.1468-1293.2007.00452.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of the study was to examine cognitive function, mood and health-related quality of life (HRQOL), and their interrelationships, among hepatitis C virus (HCV)-monoinfected and HIV/HCV-coinfected individuals. METHODS Baseline neuropsychological and HRQOL measures of HCV-monoinfected and HIV/HCV-coinfected individuals commencing HCV treatment were examined from a prospective cohort study conducted between April 2003 and August 2005 in Sydney, Australia. Participants' neuropsychological performance and HRQOL were measured using computer-based battery, Trail Making Tests (TMT), Depression Anxiety Stress Scales (DASS), the Hepatitis Quality of Life Questionnaire (HQLQ), and the Visual Analogue Scale (VAS). Neuropsychological measures of HCV-infected patient groups were compared with those of two control groups consisting of HIV-monoinfected and uninfected individuals. RESULTS Similar cognitive function, mood and HRQOL were found in HCV-monoinfected (n=19) and HIV/HCV-coinfected (n=15) individuals. When compared with the HIV-monoinfected (n=30) and uninfected control (n=30) groups, subtle cognitive impairment in attention was found in the HIV/HCV-coinfected group (P<0.05). Twenty-one percent of the HCV-monoinfected group were classified as having cognitive impairment compared with 10% or less in the other groups. Sociodemographic characteristics, mood, HRQOL and HCV indices did not correlate with cognitive function. CONCLUSIONS Our findings indicate no statistically significant difference in neuropsychological and HRQOL impairments between HIV/HCV-coinfected individuals with nonadvanced HIV disease and HCV-monoinfected individuals. This lack of significant difference may relate to the relatively small study population.
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Affiliation(s)
- Hh Thein
- National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, NSW, Australia
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Quarantini LC, Bressan RA, Galvão A, Batista-Neves S, Paraná R, Miranda-Scippa A. Incidence of psychiatric side effects during pegylated interferon- alpha retreatment in nonresponder hepatitis C virus-infected patients. Liver Int 2007; 27:1098-102. [PMID: 17845538 DOI: 10.1111/j.1478-3231.2007.01532.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVE Evaluate the incidence of mental disorders using pegylated interferon plus ribavirin retreatment in nonresponder hepatitis C virus-infected patients. METHOD The Mini-International Neuropsychiatric Interview (MINI) was used to evaluate 30 hepatitis C virus-infected interferon-nonresponder patients at baseline and following 4, 12 and 24 weeks of pegylated interferon retreatment. RESULTS During the pegylated interferon/ribavirin retreatment, 5(16.6%) patients developed psychiatric side effects: 3(10%) were diagnosed with major depressive disorder, 1(3.3%) had a brief psychotic disorder and 1(3.3%) presented with panic attacks. CONCLUSION This is the first prospective study evaluating the incidence of neuropsychiatric side effects during interferon retreatment of hepatitis C virus-infected patients, suggesting that the risk of acquiring serious psychiatric symptoms during retreatment with interferon-alpha (IFN-alpha) may not be higher than during the first antiviral therapy. This finding challenges the hypothesis that during a second treatment with IFN-alpha, patients with hepatitis C may be at greater risk for neuropsychiatric side effects than naïve patients.
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Affiliation(s)
- Lucas C Quarantini
- University Hospital, Federal University of Bahia School of Medicine, Salvador-Bahia, Brazil.
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Younossi Z, Kallman J, Kincaid J. The effects of HCV infection and management on health-related quality of life. Hepatology 2007; 45:806-16. [PMID: 17326207 DOI: 10.1002/hep.21565] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
UNLABELLED Infection with HCV leads to an array of symptoms that compromise health-related quality of life (HRQL). Chronic hepatitis C is treated primarily with pegylated interferon (peg-IFN) and an inosine 5' monophosphate dehydrogenase inhibitor, ribavirin (RBV), with the goal of achieving a sustained virologic response (SVR). SVR reduces the rate of hepatic fibrosis and other disease-related complications and, in turn, increases HRQL. Although combination therapy with peg-IFN and RBV produces SVRs in more than 50% of treated patients, it is associated with side effects that can reduce short-term HRQL, can lead to dose reductions and discontinuations, and may impair treatment response. Fatigue and depression are common symptoms of chronic HCV infection that may also be caused by IFN-based therapy. Hemolytic anemia and IFN-mediated bone marrow suppression are well-known consequences of IFN/RBV therapy, often resulting in dose reductions or discontinuations, and have the potential to affect SVR rates. Management of these symptoms is vital to successful outcomes and generally relies on therapy that is adjunctive to the primary treatment of the viral infection itself. Several new drugs with the potential to increase SVR rates without compromising HRQL are in development. CONCLUSION The relationship of chronic HCV infection, treatment, and HRQL is complex. Successful treatment of chronic hepatitis C requires an understanding of the intricacies of this relationship and appropriate management of treatment-related symptoms.
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Affiliation(s)
- Zobair Younossi
- Center for Liver Diseases, Inova Fairfax Hospital, Inova Outcomes Research Program, Inova Health System, Falls Church, VA, Annandale, VA 22003, USA.
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Guadagnino V, Trotta MP, Montesano F, Babudieri S, Caroleo B, Armignacco O, Carioti J, Maio G, Monarca R, Antinori A. Effectiveness of a multi-disciplinary standardized management model in the treatment of chronic hepatitis C in drug addicts engaged in detoxification programmes. Addiction 2007; 102:423-31. [PMID: 17298650 DOI: 10.1111/j.1360-0443.2006.01698.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIM To evaluate the effect of a multi-disciplinary standardized management model on the efficacy of pegylated (Peg)-interferon alpha-2b plus ribavirin treatment of chronic hepatitis C in drug addicts undergoing substitutive or antagonist therapy. DESIGN Observational prospective multi-centre study. SETTING Six clinical infectious disease centres in collaboration with 11 drug dependency units (DDU) in five Italian regions. PARTICIPANTS Intravenous drug users affected by chronic hepatitis C engaged in detoxification programmes. METHODS Application of a multi-disciplinary standardized management model for HCV treatment involving DDU operators, psychologists or psychiatrists and infectious disease specialists. MEASUREMENTS Very early, early, end-of-treatment and sustained virological response to Peg-interferon alpha-2b plus ribavirin. FINDINGS Fifty-three subjects were studied [43.4% with hepatitis C virus (HCV) genotypes 1 or 4]. Intent-to-treat analysis showed an end-of-treatment virological response in 58.5% of patients (39.1% genotypes 1 or 4; 73.4% genotype 3) and a sustained virological response in 54.7% (34.8% genotypes 1 or 4; 70.0% genotype 3). There were 19 (35.8%) dropouts and three (5.7%) non-responders: one genotype 1 and two genotype 4. Two (3.8%) patients relapsed: genotypes 1 and 3. On-treatment analysis showed negative HCV-RNA in 40 (93.1%) of 43 subjects who completed the first 12 treatment weeks and in 35 who completed the first 24 treatment weeks. All subjects with an end-of-treatment response, except one with genotype 3 infection, had a sustained response. CONCLUSIONS Our data show that antiviral treatment in the context of a multi-disciplinary standardized management model helps many HCV-positive drug addicts achieve a good virological response.
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Affiliation(s)
- Vincenzo Guadagnino
- Chair of Infectious Diseases, Postgraduate School of Infectious Diseases, University Magna Graecia of Catanzaro, Italy.
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Reynolds GL, Fisher DG, Jaffe A, Edwards J. Follow-up for medical care among drug users with hepatitis C. Eval Health Prof 2006; 29:355-66. [PMID: 17102060 DOI: 10.1177/0163278706296003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prevalence of hepatitis C (HCV) in injection drug users (IDUs) is high and once HCV has been detected, follow-up medical care is essential. Six hundred and one current and former IDUs who tested positive for HCV antibodies received referrals for medical care. Twenty-four percent (147) of participants returned to be interviewed regarding their medical follow-ups. Of these, only 42% (61) had sought additional medical care in the form of further liver or blood tests or liver ultrasound. Four variables predicted seeking medical care: (a) ever being in residential drug treatment, (b) ever trading sex for money, (c) self-reported homelessness, and (d) living in one's own apartment or house. Having income from a job was inversely associated with seeking medical care. Knowledge of HCV infection alone does not mean that IDUs will seek medical care. Additional education concerning medical care and treatment options are needed to address IDU needs.
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Affiliation(s)
- Grace L Reynolds
- Center for Behavioral Research and Services, California State University, Long Beach, CA 90813, USA.
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Johnson ME, Neal DB, Brems C, Fisher DG. Depression as measured by the Beck Depression Inventory-II among injecting drug users. Assessment 2006; 13:168-77. [PMID: 16672731 DOI: 10.1177/1073191106286951] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study conducts a confirmatory factor analysis of the Beck Depression Inventory-II (BDI-II) with a sample of 598 individuals who reported recent injecting drug use. Findings indicate that out of four models tested, the best model for this sample is a three-factor solution (somatic, affective, and cognitive) previously reported by Buckley, Parker, and Heggie. The findings that nearly 50% of participants provided BDI-II scores indicating significant depressive symptomatology reveals that these individuals are in need of treatment for their psychiatric symptoms as well as substance use. Somatic symptoms are endorsed more strongly than affective or cognitive symptoms of depression, suggesting a possible, but yet poorly defined, relationship between depressive symptomatology and drug use that centers on shared somatic symptomatology.
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Affiliation(s)
- Mark E Johnson
- Department of Psychology, University of Alaska Anchorage, 99508, USA.
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40
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Fireman M, Indest DW, Blackwell A, Whitehead AJ, Hauser P. Addressing tri-morbidity (hepatitis C, psychiatric disorders, and substance use): the importance of routine mental health screening as a component of a comanagement model of care. Clin Infect Dis 2006; 40 Suppl 5:S286-91. [PMID: 15768336 DOI: 10.1086/427442] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Recent studies suggest that most patients with hepatitis C virus (HCV) infection commonly present to medical clinics with active psychiatric and substance use disorders. However, routine screening for these disorders is generally not done. OBJECTIVES The purpose of our study was to assess prospectively the frequency of psychiatric and substance use disorders in patients presenting for initial assessment of a positive HCV antibody test result. METHODS A sample of 293 patients represented the majority of patients scheduled for their initial hepatology clinic visit at the Portland Veterans Affairs Medical Center between September 2002 and September 2003. The patient screening questionnaire, Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), and the Beck Depression Inventory (BDI-II) were administered to all patients. RESULTS At screening, 93% of the patients had a current or past history of at least 1 psychiatric disorder, and 73% had >or=2 disorders. The most common disorders included depression (81%), posttraumatic stress disorder (62%), any substance use disorder (58%), bipolar disorder (20%), and other psychotic disorders (17%). One hundred two patients (35%) had baseline BDI-II scores in the moderate-to-severe range of depression (>19), and 61 (21%) had AUDIT-C scores indicating current heavy alcohol use (>or=4). CONCLUSIONS Psychiatric and substance use disorders are highly prevalent among veterans with chronic hepatitis C. Thirty-five percent have significant symptoms of depression before the initiation of treatment with interferon (IFN). Routine screening for underlying psychiatric and substance use disorders and early treatment intervention before initiating antiviral therapy is essential to prevent worsening of depression and to optimize the outcome of treatment with IFN. Comanagement treatment models involving mental health care may expand the pool of patients eligible to receive treatment with IFN, as well as enhance treatment outcomes.
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Affiliation(s)
- Marian Fireman
- Northwest Hepatitis C Resource Center and Behavioral Health and Neurosciences Division, Portland, OR 97239, USA
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Litwin AH, Soloway I, Gourevitch MN. Integrating services for injection drug users infected with hepatitis C virus with methadone maintenance treatment: challenges and opportunities. Clin Infect Dis 2006; 40 Suppl 5:S339-45. [PMID: 15768345 DOI: 10.1086/427450] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Despite the high prevalence of hepatitis C virus (HCV) infection among drug users enrolled in methadone maintenance treatment programs, few drug users are being treated with combination therapy. The most significant barrier to treatment is lack of access to comprehensive HCV-related care. We describe a pilot program to integrate care for HCV infection with substance abuse treatment in a setting of maintenance treatment with methadone. This on-site, multidisciplinary model of care includes comprehensive screening and treatment for HCV infection, assessment of eligibility, counseling with regard to substance abuse, psychiatric services, HCV support groups, directly observed therapy, and enhanced linkages to a tertiary care system for diagnostic procedures. Our approach has led to high levels of adherence, with liver biopsy and substantial rates of initiation of antiviral therapy. Two cases illustrate the successful application of this model to patients with HCV infection complicated by active substance abuse and psychiatric comorbidity.
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Affiliation(s)
- Alain H Litwin
- Division of Substance Abuse, Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York 10455, USA.
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Nunes D, Saitz R, Libman H, Cheng DM, Vidaver J, Samet JH. Barriers to treatment of hepatitis C in HIV/HCV-coinfected adults with alcohol problems. Alcohol Clin Exp Res 2006; 30:1520-6. [PMID: 16930214 PMCID: PMC1592345 DOI: 10.1111/j.1530-0277.2006.00183.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Alcohol use and human immune deficiency virus (HIV) infection are both associated with accelerated progression of hepatitis C virus (HCV) disease and reduced response rates to interferon therapy. In this study, we assessed the prevalence of barriers to interferon treatment in a population of HIV/HCV-coinfected patients with current or past alcohol problems and the extent to which they received treatment to address the barriers. METHODS This is a cross-sectional, descriptive analysis of baseline data from a prospective study assessing the impact of HCV and alcohol use on HIV disease progression. Using consensus guidelines, subjects were categorized as having absolute, relative, or no contraindications to interferon therapy for HCV. Absolute contraindications to treatment included heavy alcohol use, decompensated liver disease, CD4 cell count <100 cells/microL, recent needle sharing, and suicidal ideation. Relative contraindications included moderate alcohol use, recent injection drug use, depressive symptoms, and CD4 cell count from 100 to 199 cells/microL. RESULTS Of 401 HIV-infected subjects, 200 were HCV RNA-positive. Fifty-three percent had an absolute contraindication to interferon therapy, 35% a relative but no absolute contraindication, and only 12% had no contraindication. Of those with an absolute contraindication, 61% reported heavy drinking and the majority (88%) had multiple contraindications. These contraindications were present despite the fact that over 50% were in receipt of substance abuse and mental health treatment. CONCLUSIONS Continued alcohol and drug use as well as depressive symptoms are the major barriers to interferon therapy in HCV/HIV-coinfected subjects and these barriers persist despite high treatment rates for these problems. Therefore, more intensive treatments of alcohol, drug, and mental health issues are needed to improve HCV treatment eligibility in HCV/HIV-coinfected persons.
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Affiliation(s)
- David Nunes
- Section of Gastroenterology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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Reynolds GL, Wells RS, Fisher DG, Cagle HH. Health services usage by Alaskan injection drug users. J Ethn Subst Abuse 2006; 5:23-34. [PMID: 16635972 DOI: 10.1300/j233v05n02_02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The purpose of this study was to explore health services usage among injection drug users in Anchorage, Alaska. DESIGN 645 participants were recruited as part of a federally funded study of needle exchanges. They completed a health services usage questionnaire that elicited information on use of a health care provider (physician or nurse) and emergency room services. Chi-square and t-tests were used for the bivariate analyses, and multiple logistic regression was used to develop the final predictive models. RESULTS The majority of respondents (n = 646) were male (77 percent). Race/ethnicity included 58 percent White, 22 percent Alaska Native, and 20 percent African American. The multivariate model predicting accessing a health care provider (HCP) included ever having had chlamydia (OR 2.7, CI 1.6, 4.5), current income from welfare or public assistance (OR 2.6, CI 1.7, 3.9), current income from disability (OR 5.0, CI 2.2, 11.4), current income from SSI (OR .30, CI .12, .77) and the number of days in the last 30 used opiates other than heroin (OR 1.04, CI 1.002, 1.078). The multivariate model predicting use of an emergency room (ER) was similar to that predicting use of an HCP, with the additional finding of a negative association between being African American and ER use. CONCLUSION The role of public assistance benefits enabling access to health care for IDUs has policy implications. Large public programs, such as the Indian Health Service, paid for much of the health care received by the IDUs recruited as part of this study.
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Affiliation(s)
- Grace L Reynolds
- Center for Behavioral Research and Services, California State University, 1090 Atlantic Avenue, Long Beach, CA 90813, USA.
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44
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Libman H, Saitz R, Nunes D, Cheng DM, Richardson JM, Vidaver J, Alperen JK, Samet JH. Hepatitis C infection is associated with depressive symptoms in HIV-infected adults with alcohol problems. Am J Gastroenterol 2006; 101:1804-10. [PMID: 16780562 PMCID: PMC1592346 DOI: 10.1111/j.1572-0241.2006.00616.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Depression is common in persons with HIV infection and with alcohol problems, and it has important prognostic implications. Neurocognitive dysfunction has been reported with chronic hepatitis C virus (HCV) infection. We hypothesized that HCV infection is associated with more depressive symptoms in HIV-infected persons with a history of alcohol problems. METHODS We performed a cross-sectional analysis of baseline data from a prospective cohort study of 391 HIV-infected subjects with a history of alcohol problems, of whom 59% were HCV antibody (Ab) positive and 49% were HCV RNA-positive. We assessed depressive symptoms (Center for Epidemiologic Studies Depression [CES-D]) and past month alcohol consumption. In the primary analysis, we evaluated whether there were more depressive symptoms in HCV Ab-positive and RNA-positive subjects in unadjusted analyses and adjusting for alcohol consumption, gender, age, race, CD4 count, homelessness, drug dependence, and medical comorbidity. RESULTS Mean CES-D scores were higher in subjects who were HCV Ab-positive compared with those who were HCV Ab-negative (24.3 vs 19.0; p < 0.001). In adjusted analyses, the difference in CES-D scores between HCV Ab-positive and Ab-negative subjects persisted (24.0 vs 19.0; p < 0.001). Unadjusted mean CES-D scores were also significantly higher in HCV RNA-positive subjects compared with those who were RNA-negative, and the difference remained significant (24.6 vs 19.3; p < 0.001) in adjusted analyses. CONCLUSIONS HCV/HIV coinfected persons with a history of alcohol problems have more depressive symptoms than those without HCV, and this association is unexplained by a variety of population characteristics. These data suggest that HCV may have a direct effect on neuropsychiatric function.
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Affiliation(s)
- Howard Libman
- Division of General Medicine and Primary Care and Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA
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Clifford DB, Yang Y, Evans S. Neurologic consequences of hepatitis C and human immunodeficiency virus coinfection. J Neurovirol 2006; 11 Suppl 3:67-71. [PMID: 16540458 DOI: 10.1080/13550280500513762] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) share overlapping, large worldwide distribution. The implications of coinfection are being explored because of the importance of these viruses and demographic factors that favor coinfection. The nervous system is affected by HIV in a variety of ways resulting in significant disease of all levels of the nervous system. Emerging evidence that HCV can also impact the nervous system raises concerns that detrimental interactions might occur. Several reports addressing the manifestations of coinfection support independent contributions for both HIV and HCV on central nervous system performance, but not on distal sensory neuropathy. Neuropsychological testing reveals independent contributions resulting in poorer performance in coinfection in several drug-abusing cohorts. Motor physiologic testing substantiates performance deficits from HCV in coinfected subjects as does testing in treatment naive coinfected subjects. Although ongoing deficits attributed to HCV may be seen during HIV treatment, these deficits may be less apparent in advanced HIV disease. Current evidence supports independent contributions of HCV and HIV to neurological impairment. Preliminary evidence suggests that coinfection-related impairment does not appear to accelerate HIV-1-associated cognitive disease.
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Affiliation(s)
- David B Clifford
- Washington University School of Medicine, St.Louis, MI 63110, USA.
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Lim JK, Cronkite R, Goldstein MK, Cheung RC. The impact of chronic hepatitis C and comorbid psychiatric illnesses on health-related quality of life. J Clin Gastroenterol 2006; 40:528-34. [PMID: 16825936 DOI: 10.1097/00004836-200607000-00012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
GOALS To determine the relative impact of chronic hepatitis C (CHC) and comorbid psychiatric illness on the health-related quality of life (HRQoL). BACKGROUND Psychiatric conditions are more common among patients with CHC but their relative influence on HRQoL is not well understood. STUDY We identified 864 veterans who had previously completed a veteran-specific HRQoL questionnaire (SF-36V) as part of the 1999 VA Large Health Survey with known HCV antibody (anti-HCV) status before the survey. For 201 anti-HCV(+) and 663 anti-HCV(-) patients, we compared the HRQoL status and the prevalence of 6 major psychiatric diagnoses. We conducted multiple regression analyses to measure the effect of anti-HCV status and psychiatric comorbidity. RESULTS Compared with the anti-HCV(-) group, anti-HCV(+) veterans were more likely to have alcohol dependence (P<0.001), depression (P=0.01), or posttraumatic stress disorder (PTSD) (P<0.004). The anti-HCV(+) group also reported lower HRQoL on 4 of the 8 SF-36V subscales (P<0.01) and the mental component summary scale (P<0.001). Even after adjusting for demographic variables and comorbid psychiatric illness, anti-HCV(+) patients reported a significantly lower mental component summary score (P<0.01) than did anti-HCV(-) patients. Multiple regression analysis found that depression and PTSD predicted lower HRQoL scores for all 8 HRQoL subscales (P<0.01) and both the physical (P<0.001) and mental component (P<0.03) summary scales independent of anti-HCV status. CONCLUSIONS The HRQoL is significantly impaired in veterans with CHC, particularly the mental health components of HRQoL. In contrast, comorbid depression and PTSD are associated with both lower physical and mental components of HRQol, independent of CHC.
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Affiliation(s)
- Joseph K Lim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, VA Palo Alto Health Care System, Palo Alto, California 94304, USA
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Buti M, Wong J, Casado MA, Esteban R. Quality of life and cost-effectiveness of anti-HCV therapy in HIV-infected patients. J Hepatol 2006; 44:S60-4. [PMID: 16360235 DOI: 10.1016/j.jhep.2005.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Quality of life studies in chronic hepatitis C using specific questionnaires have been performed in mono-infected patients; however, these studies have just begun in HIV-HCV co-infected patients. The questionnaires used in mono-infected patients are not well adapted for co-infected patients and need to be redesigned. Typically, co-infected patients have multiple symptoms that may be attributable to HIV, to HCV, to a combination of both diseases or even to side effects related to drug therapy. These patients usually need substitutive therapy to manage side effects related to HCV therapy, particularly anaemia, leukopenia and depression. There are no cost-effectiveness studies published on the current HCV standard therapy with pegylated interferon and ribavirin. However, there is some research on the old standard interferon and ribavirin, which shows that HCV therapy is cost-effective. Cost-effectiveness studies in co-infected patients will have to take into account variables that do not affect mono-infected patients, such as the different levels of CD4, the increase in the fibrosis progression rate and the use of other expensive drugs for the management of side effects. Currently, the literature does not provide adequate information on the effect of HCV infection on the quality of life of HIV-HCV co-infected patients or the most cost-effective HCV therapy.
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Affiliation(s)
- Maria Buti
- Liver Unit, Hospital General Universitario Valle de Hebron, Paseo Valle hebron 117, Barcelona 08035, Spain.
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Castera L, Constant A, Bernard PH, de Ledinghen V, Couzigou P. Psychological impact of chronic hepatitis C: Comparison with other stressful life events and chronic diseases. World J Gastroenterol 2006; 12:1545-50. [PMID: 16570346 PMCID: PMC4124286 DOI: 10.3748/wjg.v12.i10.1545] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To examine the psychological impact of chronic hepatitis C (CHC) diagnosis in a large cohort of CHC patients as compared with other stressful life events and chronic diseases carrying a risk of life-threatening complications.
METHODS: One hundred and eighty-five outpatients with compensated CHC were asked to self-grade, using a 100-mm visual analogue scale (VAS), the degree of stress caused by the learning of CHC diagnosis and the perceived severity of their disease. Diagnosis-related stress was compared to four other stressful life events and perceived CHC severity was compared to four other common chronic diseases.
RESULTS: Learning of CHC diagnosis was considered a major stressful event (mean ± SD scores: 72 ± 25), significantly less than death of a loved-one (89 ± 13, P < 0.0001) and divorce (78 ± 23, P < 0.007), but more than job dismissal (68 ± 30, P < 0.04) and home removal (26 ± 24, P < 0.0001). CHC was considered a severe disease (74 ± 19), after AIDS (94 ± 08, P < 0.001) and cancer (91 ± 11, P < 0.001), but before diabetes (66 ± 23, P < 0.001) and hypertension (62 ± 20, P < 0.001). Perceived CHC severity was not related to the actual severity of liver disease, assessed according to Metavir fibrosis score. In multivariate analysis, diagnosis-related stress was related to perceived disease severity (P < 0.001), trait anxiety (P < 0.001) and infection through blood transfusion (P < 0.001).
CONCLUSION: Our results show the considerable psychological and emotional burden that a diagnosis of CHC represents, even in the absence of significant liver disease. They should be taken into account when announcing a diagnosis of CHC in order to reduce its negative effects.
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Affiliation(s)
- Laurent Castera
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut Lévêque, Avenue Magellan, 33604 Pessac, France.
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Stumpf BP, Rocha FL, Proietti ABDFC. Infecções virais e depressão. JORNAL BRASILEIRO DE PSIQUIATRIA 2006. [DOI: 10.1590/s0047-20852006000200007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJETIVO: A associação entre depressão e viroses é estudada há quase dois séculos, com resultados conflitantes. O objetivo deste trabalho é fazer uma análise crítica dos estudos existentes na literatura sobre essa relação. MÉTODOS: A pesquisa bibliográfica utilizou as fontes eletrônicas de busca MEDLINE e LILACS (1966 a agosto 2005). As referências dos artigos foram utilizadas como fonte adicional de consulta. RESULTADOS: Foram abordados os trabalhos que trataram da associação entre depressão e os vírus HIV, HCV, EBV, influenza, HSV, HBV, HAV, BDV e HTLV. A relação entre HIV e depressão mostrou-se bem documentada na literatura. Existem indícios de que a prevalência desse transtorno nos indivíduos infectados pelo HIV seja maior que a encontrada nos soronegativos. Além disso, estudos constataram que a depressão está associada a pior prognóstico da infecção. Quanto à associação entre HCV e depressão, os trabalhos sugeriram maior prevalência desse transtorno psiquiátrico nos portadores do HCV comparados à população geral. Não existem evidências científicas suficientes para dar suporte à relação entre os demais vírus e depressão. CONCLUSÃO: As associações mais bem fundamentadas foram aquelas entre depressão e os vírus HIV e HCV. A relação entre as demais viroses e depressão precisa ser mais bem estudada, e trabalhos com delineamento adequado se fazem necessários.
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Walley AY, White MC, Kushel MB, Song YS, Tulsky JP. Knowledge of and interest in hepatitis C treatment at a methadone clinic. J Subst Abuse Treat 2005; 28:181-7. [PMID: 15780548 DOI: 10.1016/j.jsat.2004.12.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Revised: 11/04/2004] [Accepted: 12/01/2004] [Indexed: 02/06/2023]
Abstract
This study describes knowledge about hepatitis C virus (HCV) infection and interest in treatment among 110 opiate dependent patients from an opiate dependence treatment program in San Francisco. None had been treated for HCV and only 30% had been evaluated for HCV treatment. While only 34% knew about HCV treatment, 54% of the sample became "definitely interested" in HCV treatment after hearing the risks and benefits. Men were approximately five times more likely than women to know of some HCV treatment. Whites were seven times and Latinos were about six times more likely than African-Americans to know about HCV treatment. Our findings suggest that methadone programs can play an important role in increasing access to HCV treatment through educating patients about treatment options.
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