Chronic hepatitis C and antiviral treatment regimens: Where can psychology contribute?

Abstract

Objective To evaluate the existing literature on psychological, social, and behavioral aspects of chronic hepatitis C viral (HCV) infection and antiviral treatment; provide the state of the behavioral science in areas that currently hinder HCV-related health outcomes; and make recommendations for areas in which clinical psychology can make significant contributions. Methods The extant literature on HCV and antiviral therapy was reviewed as related to biopsychosocial factors such as mental health, substance/alcohol use, quality of life, coping, stigma, racial disparities, side effects, treatment adherence, integrated care, and psychological interventions. Results For reasons that have not been well elucidated, individuals infected with HCV experience psychological and somatic problems and report poor health-related quality of life. Preexisting conditions, including poor mental health and alcohol/substance use, can interfere with access to and successful completion of HCV treatment. Perceived stigma is highly prevalent and associated with psychological distress. Racial disparities exist for HCV prevalence, treatment uptake, and treatment success. During HCV treatment, patients experience exacerbation of symptoms, treatment side effects, and poorer quality of life, making it difficult to complete treatment. Despite pharmacological advances in HCV treatment, improvements in clinical and public health outcomes have not been realized. The reasons for this lack of impact are multifactorial, but include suboptimal referral and access to care for many patients, treatment-related side effects, treatment nonadherence, and lack of empirically-based approaches. Conclusions Biomedical advances in HCV and antiviral treatment have created a fertile field in which psychologists are uniquely positioned to make important contributions to HCV management and treatment.

“Hepatitis C treatment turned me around:” Psychological and behavioral transformation related to hepatitis C treatment

“…HCV- and substance use-related stigma have been associated with reluctance to disclose HCV status, initiate HCV treatment, and engage in HCV care (Astone-Twerell et al, 2006; Evon et al, 2013; Paterson et al, 2007; Zickmund et al, 2003). While the side effect profiles of interferon-based treatment for HCV likely prevented some HCV-infected individuals from initiating HCV treatment, the advent of lower side effect burden HCV treatment options has reduced individual-level barriers related to side effects (Wei et al, 2014).…”

The Effectiveness of Nursing Intervention Program on Emotional Distress, Self-Efficacy, and Liver Enzymes Among Hepatitis C Virus Patients Undergoing Antiviral Treatment Therapy (Sovaldi Medication)

“…However, the evidence demonstrating the efficacy of antidepressants in ameliorating IFN-induced depression is equivocal [10] and [11]. Pharmacotherapy also has limitations (e.g., patient reluctance due to side effects, addiction history, and liver toxicity) and does not build self-efficacy or coping skills to empower patients to self-manage symptoms [6].…”

“…Individuals infected with HCV experience psychological and somatic problems and report poor health-related quality of life. During HCV treatment, patients experience exacerbation of symptoms, treatment side effects, and poorer quality of life, making it difficult to complete treatment [6]. Also, reference [7] "stated that treatment of chronic HCV infection may temporarily worsen HRQoL, and common adverse effects of currently available agents include fatigue, muscle aches, depression and cognitive deficits".…”

“…However, many treatment discontinuations and dose reductions may be due more to patients' inability to tolerate symptoms that interfere with life functioning [6]. Antidepressant medications have been the most readily available therapeutic option for HCV specialists to manage their patients' emotional distress.…”

Health-Related Quality of Life in patients with hepatitis C in double and triple therapy

“…It is known that chronic hepatitis C causes a decline in HRQoL indexes, even without advanced liver disease (19)(20) . In a systematic review including 15 studies, patients with chronic hepatitis C without signs of advanced disease declined in HRQoL of the SF-36 in both physical and mental component summary (21) .…”