Hepatitis C Treatment Completion in Individuals With Psychiatric Comorbidity and Depression

Abstract

Hepatitis C virus is a common bloodborne pathogen. Patient, provider, and health care system factors combine to constrain access to treatment and have led to low rates of treatment initiation and continuation among medically eligible individuals. Behavioral health comorbidity, which is common in the patient population, has historically been an exclusion criterion and is one such barrier to care. We implemented an interdisciplinary nurse-managed primary care-based hepatitis C evaluation and treatment program to address behavioral health needs concurrently in an effort to increase treatment initiation and continuation rates among comorbid individuals. We found no association between having a psychiatric or substance use history and treatment discontinuation in our patient cohort. Likewise, there was no association in our cohort between becoming depressed or anxious while undergoing treatment and treatment discontinuation. The results of our study concur with others that have shown that addressing behavioral health comorbidities concurrently with hepatitis C evaluation and treatment may improve treatment continuation rates among comorbid patients, thereby helping to remove barriers to treatment of chronic hepatitis C.

Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors

“…Provider reticence is documented as stemming from: concerns about treatment adherence among PWID [49,50]; the impact of psychiatric co-morbidities [51], HIV co-infection [37,52] and/or current alcohol and drug consumption [13,53,54]; as well as potential HCV re-infection [55,56]; and a presumption of a lack of interest from clients [39]. A growing body of literature evidences that many of these provider concerns should not preclude consideration for HCV treatment, with: adherence among cohorts of PWID equalling that of other patient groups [14,16,57]; low re-infection occurrences [55,56,58]; treatment successes among current drug and alcohol users [13,14,16,22,53,59-61]; as well as those with psychiatric co-morbidities [51,62,63] and HIV [64-66]. While HCV treatment can be complicated by HIV comorbidity, including antiretroviral drug-drug interactions and co-occurring antiviral toxicity [65,67,68], a 48 week treatment with peginterferon plus ribavirin for all genotypes has been found to be effective in co-infected individuals, including for PWID [65,69].…”

“…Reticence to treat PWID with psychiatric conditions is understandable, given the neuropsychiatric adverse effects associated with interferon treatment, including impairment in concentration, depression, insomnia, and irritability [71,72]. Yet people with psychiatric histories can adhere to and complete HCV treatment at rates as high as others, if their mental health status is closely monitored and treated [51,62,72]. This may involve prophylactic antidepressant therapy before beginning HCV treatment in patients thought to have a high risk of depression [51,72].…”

Withdrawing interferon-α from psychiatric patients: clinical care or unjustifiable stigma?

“…In fact, there is reasonably good evidence in favour of use of antidepressants, for both prophylaxis and treatment of anxiety and depressive symptoms induced by IFN-α (Baraldi et al 2012). In addition, the early involvement of a multidisciplinary therapeutic approach, such as the assessment and follow-up with liaison psychiatrists and psychologists (Neri et al 2010), or an interdisciplinary nurse-managed treatment programme, can be used to support patients with pre-existent psychiatric problems undergoing IFN-α therapy (Gardenier et al 2011). It should be noted that it is important not to underestimate the fact that patients with no psychiatric history have virtually the same risk of developing IFN-α-induced side-effects, and as such they may suffer even more from the lack of management programmes and prophylactic strategies.…”

Multimethod assessment of baseline depression and relationship to hepatitis C treatment discontinuation

“…11,38 The majority of studies, however, have found no effect of depression or depression symptoms at baseline on early treatment discontinuation or SVR. [39][40][41][42][43][44][45][46][47] One study found that baseline depression did lead to more treatment discontinuation but did not impact SVR rates. 48 Another study that excluded subjects with a history of depression found that the development of depression during treatment positively predicted achievement of SVR.…”