Does prophylactic antidepressant treatment boost interferon-alpha treatment completion in HCV?

A Survey on the Prevalence of Depression in Blood Donors with Hepatitis C in Shiraz

BACKGROUND

Depression is the most common psychiatric disorder associated with hepatitis C.

OBJECTIVES

This study aimed to survey the prevalence rate of depression in patients with Hepatitis C Virus (HCV) before they were aware of their HCV test result.

METHODS

This cross-sectional study was conducted on all blood donors with confirmed positive HCV test results who donated blood between March 21, 2012 to March 21, 2013 at Fars blood transfusion center in Iran as case group and age- and sex-matched blood donors with negative screening test results as control group. A semi-structured interview based on DSM IV-TR depressive disorder criteria and Beck depression inventory (BDI) was conducted. BDI contained 21 items, each scored from 0 to 3 and total score of 0 to 63 for the whole scale computed by summing up all the items. A cut-off score of ≥ 19 indicated clinically significant depressive symptoms. The prevalence rate and risk factors of depression were determined.

RESULTS

The most frequent risk factors for HCV infection were intravenous drug abuse (59.3%), unsafe sexual contact (30.5%), and history of being imprisoned (25.4%). The prevalence rate of depression in the HCV group was 55.9 % (95% CI: 42.99% - 68.87%) that was significantly higher than the corresponding rate of the control group as 17.7 % ( 95% CI: 8.49% - 28.79%) (P < 0.001). The severity of depression was also more in the HCV group (P < 0.001). Besides, the prevalence rate of depression was higher among HCV patients with lower education level, previous history of drug abuse, unsafe sexual contact, and previous history of psychiatric diseases. The prevalence rate of depression was higher in the case group even after adjusting for other variables.

CONCLUSIONS

Our study underlined the remarkable prevalence of depression among HCV patients. Therefore, designing depression screening tests is suggested to help such patients before starting the treatment.

Systematic review: patient-reported outcomes in chronic hepatitis C--the impact of liver disease and new treatment regimens

BACKGROUND

Treatment for chronic hepatitis C (CH-C) is rapidly changing and moving away from an interferon and ribavirin-based therapy to interferon-free ribavirin-free all oral regimens. These regimens are simpler and shorter to administer with very high efficacy rates and better side effect profiles. As advances in the treatment of CH-C occur, it is imperative to capture both clinical outcomes (efficacy and safety) as well as patient-reported outcomes (PROs). In fact, PROs assesses and quantifies the impact of these regimens on patient experience. PROs assess patients' health-related quality of life (HRQOL) especially in the realms of fatigue and neuropsychiatric issues such as depression which can affect treatment adherence and work productivity.

AIM

To review the literature related to PRO's in HCV patients and summarise the impact of CH-C and its treatment on PROs.

METHODS

Databases Ovid MEDLINE and PubMed were searched from 1990 to October 2014 using a combination of MEsh, thesaurus terms and relevant text words: hepatitis C, CH-C, treatment, quality of life, health-related quality of life, fatigue, work productivity, adherence, patient-reported outcomes, direct acting anti-viral agents and second generation direct acting anti-viral agents. Each manuscript was assessed for pertinence to the issue of PROs in CH-C as well as the quality of study design and publications.

RESULTS

From the literature, it is evident that CH-C patients have baseline PRO impairment. Furthermore, treatment with interferon with or without ribavirin and first generation DAAs causes additional PRO burden which can negatively impact treatment adherence and indirectly, treatment efficacy and work productivity. The new treatment regimens with interferon- and ribavirin-free regimens not only have very high efficacy, but also result in the improvement of PRO scores as early as 2 weeks into treatment as well as possibly better adherence to treatment regimens.

CONCLUSIONS

CH-C and its treatment have been associated with patient-reported outcome impairment. The new IF-free and RBV-free regimens are associated with high efficacy and substantial improvement of patient-reported outcomes in clinical trial setting. Although very encouraging, more data are needed to assess patient-reported outcomes, adherence and work productivity of CH-C patients in the real world setting of clinical practice.

What psychiatric screening and monitoring might be needed with the new generation of hepatitis C treatments?

Psychiatric difficulties, including depression and alcohol use disorders, pose a challenge to treatment decision-making for chronic hepatitis C. This is especially made worse because interferon-alpha, as part of the standard of care, may exacerbate depressive symptoms and cause suicidal symptoms to appear. This requires a treatment setting that has the capacity to carry out psychiatric assessment and monitoring, and the capability to deliver patient education regarding these aspects of care. Psychiatric comorbidities create a challenging decision-making situation, especially since success rates for the most common hepatitis C genotype, genotype 1, hover around 40%. In recent years, new treatments have emerged. These significantly boost the likelihood of sustained viral response, including for genotype 1, and do not seem to have the side effects of interferon-alpha or ribavirin. Relevant data are reviewed to assess the degree that these new treatments might reduce the portion not eligible for treatment due to psychiatric comorbidities, and might reduce the emergence of psychiatric symptoms during treatment. Several organizations have recently released evidence-based treatment recommendation guidelines. It is apparent that interferon-alpha continues to be a standard of care, with the new drugs added to this recognized regimen in order to shorten treatment and to boost efficacy. Clinical settings must continue to assess appropriateness for treatment, including current or recent psychiatric comorbidities, and must continue to closely monitor patients for the emergence of psychiatric side effects. The newly developed hepatitis C treatments may affect the metabolism of several categories of psychiatric drugs, and so drug-drug interactions must also be considered and monitored. With many promising drugs under development, an all-pill regimen, with no interferon-alpha and no ribavirin, may emerge in the near future. This will greatly change the challenge of treatment decision-making, and should expand the portion of patients able to successfully complete a treatment regimen.