Effects of Direct-Acting Antiviral Agents on the Mental Health of Patients with Chronic Hepatitis C: A Prospective Observational Study

Abstract

In chronic hepatitis C (CHC) patients, interferon-based treatments showed toxicity, limited efficacy, and psychiatric manifestations. Direct-acting antiviral (DAA) agents appeared safer, though it remains unclear if they may exacerbate or foster mood symptoms in drug-naïve CHC patients. We evaluated 62 CHC patients’ mental status, before and 12 weeks after DAA therapy, by assessment scales and psychometric instruments. We subdivided patients into two groups, CHC patients with (Group A) or without (Group B) a current and/or past psychiatric history. After DAA treatment, Group A patients showed low anxiety and improved depression, no variation in self-report distress, but worse general health perceptions. No significant difference emerged from coping strategies. Depression and anxiety improved in Group B, and no change emerged from total self-reported distress, except for somatization. Moreover, Group B increased problem-focused strategies for suppression of competing activities, and decreased strategies of instrumental social support. Contrarily, Group B reduced significantly emotion-focused strategies, such as acceptance and mental disengagement, and improved vitality, physical and social role functioning. DAA therapy is safe and free of hepatological and psychiatric side effects in CHC patients, regardless of current and/or past psychiatric history. In particular, patients without a psychiatric history also remarkably improved their quality of life.

A Review on Extrahepatic Manifestations of Chronic Hepatitis C Virus Infection and the Impact of Direct-Acting Antiviral Therapy

“…Treatment with DAA has been shown to be safe in psychiatric subjects. In a small population, elimination of HCV by DAAs has been shown to improve anxiety and de-pression [98], although another study could not find an impact on anxiety or depression during or after HCV treatment by DAA [99]. Other studies have evidenced the possibility of an improvement in cognitive functions after viral eradication by DAA [100,101].…”

Neuropsychiatric disorders in chronic hepatitis C patients after receiving interferon or direct-acting antivirals: a nationwide cohort study

“…There was no significant difference between the Tx-naïve DAA group and IFN group in the risk of other NPDs which included psychotic disorders and cognitive disorders (HR = 1.11, 95% CI: 0.45–2.73, p = 0.819). However, improving cognitive and neuropsychological outcomes among the CHC patients achieving SVR has been shown in several studies conducted using self-control scale measurement in a short follow-up time ( Barbosa et al, 2017 ; Evon et al, 2019 ; Hassaan et al, 2019 ; Kesen et al, 2019 ; Fabrazzo et al, 2020 ; Vaghi et al, 2020 ; Ibáñez-Samaniego et al, 2022 ; Kaur et al, 2022 ; Mahran et al, 2022 ). The previous studies evaluated differences in mean scores of symptom clusters between pre-treatment and post-treatment assessment, at 12 weeks to 6 months after therapy completion.…”

“…The neuropsychological outcome after DAA therapy has also been evaluated. Most of recent observational studies using scale measurement showed CHC patients treated with DAAs experienced trends for improved outcome ( Gallach et al, 2018 ; Sundberg et al, 2018 ; Evon et al, 2019 ; Goñi Esarte et al, 2019 ; Kesen et al, 2019 ; Fabrazzo et al, 2020 ; Vaghi et al, 2020 ). In a multicenter observational study of 1601 CHC patients treated with DAAs between 2016 and 2017, post-treatment scores in domains of depression, anxiety, and cognitive concern showed significant improvements from the baseline scores among the SVR cohort ( Evon et al, 2019 ).…”

A Multivariate Analysis of Depression Prevalence in Psoriasis Patients: A Cohort Study

“…Consequently, in our severe psoriasis patients, a relationship might exist between behavioral disengagement and the severity of psychological distress due to depression. Instead, patients affected by other chronic disorders managed the disease-related psychological distress by using coping strategies other than behavioral disengagement [ 57 , 58 , 60 , 61 ].…”