Antiviral Completion Rates and Sustained Viral Response in Hepatitis C Patients With and Without Preexisting Major Depressive Disorder

Abstract

Background-Despite evidence suggesting that the majority of patients with hepatitis C virus (HCV) have psychiatric and substance use disorders, patients with these comorbidities have historically been excluded from antiviral therapy for HCV.

Psychological, lifestyle and social predictors of hepatitis C treatment response: a systematic review

“…Previous research has shown that patients with psychiatric illnesses are often excluded from treatment , but the articles identified in our review found that this group achieved comparable SVR rates to controls if they completed therapy . Despite significantly higher discontinuation rates in this population, they could be treated successfully if offered adjunctive education and support to improve treatment completion .…”

“…SVR rates of 56–63% are reported in registration trials, in contrast to rates of 10–57% in the studies we identified that include patients with psychiatric illness . Cure rates for patients with psychiatric illness were reported to be equal or even higher than controls in some of the studies we analysed . However, caution must be applied to the results, as only patients who completed treatment were included, and high discontinuation rates would result in poorer outcomes if intention‐to‐treat analysis had been performed, as in most clinical trials.…”

“…Sixty‐five per cent of the studies were published in 2006 or later, with 18% published in 2010. The number of articles analysed in each category was: psychological factors: 12 ; socioeconomic status: 10 ; and lifestyle factors: 19 (alcohol consumption: 10 and the impact of weight, obesity, or BMI and diet: 9 ). Five studies were included in more than one category .…”

“…To determine whether psychiatric illness has an impact on SVR, treatment adherence or discontinuation rates, twelve studies that reported on these factors were analysed (Table S1). Four studies specifically examined depressive symptoms; five researched general psychiatric issues; major depressive disorder, schizophrenia and severe mental illness were analysed in one study each. Ten of the studies found no significant relationship between depressive symptoms, general mental or psychiatric illness, schizophrenia or major depressive disorder and treatment failure, with SVR rates ranging between 10 and 58.5%.…”

Co-occurring Depression, Chronic Pain and Substance Use Disorders in People with Hepatitis C

“…Prevention of IFN-induced depression by using antidepressants prophylactically has been shown to be effective in individuals who previously had IFN-induced depression [13, 51, 70 -72]. A retrospective case series that compared Veterans with HCV and no pre-existing depression to those with HCV and pre-existing depression treated with antidepressants prior to beginning antiviral therapy did not find differences in completion rates or SVR between groups [73]. Also, a recent randomized double-blind placebo-controlled study that monitored patients for IFN-induced depression after antiviral therapy was initiated and randomized them to either citalopram or placebo showed benefits in alleviating depressive symptoms with citalopram but not placebo [74].…”