Evaluating psychiatric outcomes associated with direct-acting antiviral treatment in veterans with hepatitis C infection

Abstract

Introduction:Approximately 70% of veterans with hepatitis C virus infection have at least one psychiatric illness. The advent of direct-acting antiviral (DAA) therapy provided an alternative to interferon-alpha regimens and revolutionized treatment, however, the extent of psychiatric effects attributed to these agents are unclear. The primary objective of this pilot study was to prospectively analyze psychiatric outcomes, specifically depression, in veterans with hepatitis C virus infection who are initiated on DAA therapy.Methods:In this single center, prospective cohort study, psychiatric outcomes were analyzed using Patient Health Questionnaire assessments at baseline and weeks 4, 8, and 12 of complete DAA treatment. Outcome analysis were stratified based on specific DAA therapy and preexisting mental illness (mental health [MH] subjects and non-MH subjects), with a sub-analysis of major depressive disorder patients.Results:Analysis included 48 patients, majority males (96%), with a mean age of 59.4 years (±8.0). Twenty-four (50%) patients had a preexisting MH diagnosis, with major depressive disorder being the most common MH diagnosis (50%, n = 12). Despite a trend toward improvement, no significant changes in questionnaire scores after 12 weeks of DAA therapy were observed for all patient groups (P > .05). Neither MH subjects nor non-MH subjects displayed a significant change in questionnaire scores from baseline to end of treatment (P > .05). No patients required acute psychiatric interventions during DAA treatment.Discussion:Treatment with DAA therapy was not associated with psychiatric decompensation. Data from this pilot study supports the safe utilization of DAA therapy in hepatitis C virus patients with preexisting MH illness as it appears to be devoid of depressive and psychiatric side effects.

Effectiveness and safety of direct‐acting antivirals in hepatitis C infected patients with mental disorders: Results in real clinical practice

“…These safety results of the psychiatric symptomatology corroborate those observed in previous studies, at the level of the evaluation on anxiety or depression, fatigue and mood, cognitive state, or sleep disturbances 56‐60 . In addition, patients with psychiatric disorders, in this study, have not developed decompensation of their mental illness during DAAs treatment, as other authors have also evaluated but limited to DAAs treatments based on ribavirin 61 …”

“…[56][57][58][59][60] In addition, patients with psychiatric disorders, in this study, have not developed decompensation of their mental illness during DAAs treatment, as other authors have also evaluated but limited to DAAs treatments based on ribavirin. 61 T A B L E 5 Multivariate analysis on SVR12…”

Impact of Direct Acting Antiviral Agents on Psychiatric and Sexual Health of Patients with Hepatitis C Virus

“…They reported that anxiety and depression scores did not change during the follow-up period (treatment period and 12 weeks after). In a study sample of veterans with and without mental health diagnosis, there was no change in depression scores evaluated by the Patient Health Questionnaire, from baseline to end of the treatment (22). No psychiatric decompensation was reported while using DAA in that study.…”

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

“…The low number of participants and the prevalent diagnosis of mixed anxiety-depressive disorders did not allow us to analyze further the differences among subgroups with other psychiatric diagnoses. Previous studies centered mainly on patients with major depressive disorders and substance abuse or dependence [12,35]. Furthermore, the advanced liver disease in some patients, the relevant comorbidities, and no patients with HIV co-infection might act as impeding factors for achieving the generalizability of our results.…”

“…Yet, differences exist in the design, sample, and size of the study, clinical and time evaluation, severity and definition of psychopathological symptoms, plus the use of self-reported or observer-rated diagnostic interview scales [29][30][31][32][33][34]. According to a few studies [12,[35][36][37][38], DAA therapy is safe and does not worsen the depressive or other psychiatric symptoms in CHC patients with pre-existing mental diseases. Other studies, differently, feature the possible onset of mood symptoms in patients with psychiatric history [15][16][17].…”