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Aas CF, Vold JH, Chalabianloo F, Løberg EM, Lim AG, Vickerman P, Johansson KA, Fadnes LT. Effect of integrated hepatitis C virus treatment on psychological distress in people with substance use disorders. Sci Rep 2024; 14:816. [PMID: 38191795 PMCID: PMC10774384 DOI: 10.1038/s41598-024-51336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024] Open
Abstract
People with substance use disorders (SUD) have a high prevalence of chronic hepatitis C virus (HCV) infection and mental health disorders. We aimed to assess the impact of integrated HCV treatment on psychological distress measured by Hopkins-symptom-checklist-10 (SCL-10). This multi-center randomized controlled trial evaluated psychological distress as a secondary outcome of integrated HCV treatment (INTRO-HCV trial). From 2017 to 2019, 289 participants were randomly assigned to receive either integrated or standard HCV treatment with direct-acting antiviral therapy. Integrated HCV treatment was delivered in eight decentralized outpatient opioid agonist therapy clinics and two community care centers; standard treatment was delivered in internal medicine outpatient clinics at centralized hospitals. Participants in the integrated treatment arm had a sustained virologic response of 93% compared to 73% for those in standard treatment arm. Psychological distress was assessed using SCL-10 prior to initiation of HCV treatment and 12 weeks after treatment completion. The mean SCL-10 score prior to HCV treatment was 2.2 (standard deviation [SD]: 0.7) for patients receiving integrated HCV treatment and 2.2 (SD: 0.8) for those receiving standard HCV treatment. Twelve weeks after the end of treatment, the mean SCL-10 score change was - 0.1 (- 0.3;0.0) in the integrated compared to the standard arm. Psychological distress did not substantially change during the treatment period and was not significantly different between the treatment arms.
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Affiliation(s)
- Christer F Aas
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
| | - Jørn Henrik Vold
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Fatemeh Chalabianloo
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kjell Arne Johansson
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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MohanKumar SMJ, Murugan A, Palaniyappan A, MohanKumar PS. Role of cytokines and reactive oxygen species in brain aging. Mech Ageing Dev 2023; 214:111855. [PMID: 37541628 PMCID: PMC10528856 DOI: 10.1016/j.mad.2023.111855] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 07/24/2023] [Accepted: 08/01/2023] [Indexed: 08/06/2023]
Abstract
Aging is a complex process that produces profound effects on the brain. Although a number of external factors can promote the initiation and progression of brain aging, peripheral and central changes in the immune cells with time, also play an important role. Immunosenescence, which is an age-associated decline in immune function and Inflammaging, a low-grade inflammatory state in the aging brain contribute to an elevation in cytokine and reactive oxygen species production. In this review, we focus on the pro-inflammatory state that is established in the brain as a consequence of these two phenomena and the resulting detrimental changes in brain structure, function and repair that lead to a decline in central and neuroendocrine function.
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Affiliation(s)
- Sheba M J MohanKumar
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA.
| | - Abarna Murugan
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA
| | - Arunkumar Palaniyappan
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA
| | - Puliyur S MohanKumar
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA
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Gutiérrez-Rojas L, de la Gándara Martín JJ, García Buey L, Uriz Otano JI, Mena Á, Roncero C. Patients with severe mental illness and hepatitis C virus infection benefit from new pangenotypic direct-acting antivirals: Results of a literature review. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:382-396. [PMID: 35718017 DOI: 10.1016/j.gastrohep.2022.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Hepatitis C virus (HCV) infection is a global health problem that can results in cirrhosis, hepatocellular carcinoma and even death. HCV infection is 3-20-fold more prevalent among patients with versus without severe mental illness (SMI), such as major depressive disorder, personality disorder, bipolar disorder and schizophrenia. Treatment options for HCV were formerly based on pegylated interferon alpha, which is associated with neuropsychiatric adverse events, and this contributed to the exclusion of patients with SMI from HCV treatment, elimination programmes, and clinical trials. Moreover, the assumption of poor adherence, scant access to healthcare and the stigma and vulnerability of this population emerged as barriers and contributed to the low rates of treatment and efficacy. METHODS This paper reviews the literature published between December 2010 and December 2020 exploring the epidemiology of HCV in patients with SMI, and vice versa, the effect of HCV infection, barriers to the management of illness in these patients, and benefits of new therapeutic options with pangenotypic direct antiviral agents (DAAs). RESULTS The approval of DAAs has changed the paradigm of HCV infection treatment. DAAs have proven to be an equally efficacious and safe option that improves quality of life (QoL) in patients SMI. CONCLUSIONS Knowledge of the consequences of the HCV infection and the benefits of treatment with new pangenotypic DAAs among psychiatrists can increase screening, referral and treatment of HCV infection in patients with SMI.
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Affiliation(s)
| | | | - Luisa García Buey
- Gastroenterology Department, Liver Unit, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan I Uriz Otano
- Gastroenterology Department, Liver Unit, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Álvaro Mena
- Infectious Diseases Unit, Internal Medicine Service, Clinical Virology Group, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidade da Coruña, Coruña, Spain
| | - Carlos Roncero
- Psychiatry Service, University of Salamanca Health Care Complex and Psychiatric Unit, School of Medicine, Institute of Biomedicine, University of Salamanca, Salamanca, Spain
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Chang RY, Hsueh-Hua Ho S, Tsai HL, Koo M. Association of anxiety and depression with chronic liver diseases in patients with noncardiac chest pain: A cross-sectional study. Medicine (Baltimore) 2022; 101:e29620. [PMID: 35945771 PMCID: PMC9351862 DOI: 10.1097/md.0000000000029620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Causes of chest pain can vary from benign to life-threatening conditions, and in many cases not necessary of cardiac origin. A possible reason for noncardiac chest pain could be anxiety or depression caused by chronic liver diseases. The aim of this study was to investigate the association of anxiety and depression with chronic liver disease in patients with noncardiac pain. Patients with chest tightness or pain referred for treadmill exercise testing were recruited from a regional hospital in southern Taiwan. Medical records of the patients were used to define the presence and type of chronic liver disease. Multiple logistic regression analyses were conducted to assess the association of anxiety and depression with chronic liver disease. A total of 2537 patients with liver function test results and abdominal sonography data were analyzed, and 1965 patients showed a negative treadmill exercise testing. The mean age of these 1965 patients was 51.9 years and 54.2% were male. The prevalence of alcoholic liver disease, hepatitis B, hepatitis C, and fatty liver disease was 10.6%, 10.9%, 3.7%, and 27.0%, respectively. Results from multiple logistic regression analyses showed that the risk of anxiety (adjusted odds ratio [aOR] = 1.83, P < .001) and depression (aOR = 1.85, P < .001) was significantly higher in patients with alcoholic liver disease. Anxiety was significantly higher in patients with fatty liver disease (aOR = 1.30, P = .031), and the risk of depression was significantly higher in patients with chronic hepatitis C (aOR = 2.18, P = .005). In conclusion, in patients with noncardiac chest pain, alcoholic liver disease was significantly associated with anxiety and depression, while those with fatty liver and chronic hepatitis C were associated with anxiety and depression, respectively. Clinicians should be vigilant to these correlations in their practice.
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Affiliation(s)
- Rei-Yeuh Chang
- Division of Cardiology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
- Min-Hwei Junior College of Health Care Management, Tainan City, Taiwan
| | | | - Han-Lin Tsai
- Division of Cardiology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Malcolm Koo
- Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien City, Hualien, Taiwan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- * Correspondence: Malcolm Koo, PhD, Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien City, Hualien 970302 Taiwan (e-mail: )
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Marathe G, Moodie EEM, Brouillette MJ, Lanièce Delaunay C, Cox J, Martel-Laferrière V, Gill J, Cooper C, Pick N, Vachon ML, Walmsley S, Klein MB. Impact of Hepatitis C Virus Cure on Depressive Symptoms in the Human Immunodeficiency Virus-Hepatitis C Virus Coinfected Population in Canada. Clin Infect Dis 2022; 76:e702-e709. [PMID: 35789253 PMCID: PMC9907551 DOI: 10.1093/cid/ciac540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/21/2022] [Accepted: 06/30/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Depression is common in people with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), with biological and psychosocial mechanisms at play. Direct acting antivirals (DAA) result in high rates of sustained virologic response (SVR), with minimal side-effects. We assessed the impact of SVR on presence of depressive symptoms in the HIV-HCV coinfected population in Canada during the second-generation DAA era (2013-2020). METHODS We used data from the Canadian CoInfection Cohort (CCC), a multicenter prospective cohort of people with a HIV and HCV coinfection, and its associated sub-study on food security. Because depression screening was performed only in the sub-study, we predicted Center for Epidemiologic Studies Depression Scale-10 classes in the CCC using a random forest classifier and corrected for misclassification. We included participants who achieved SVR and fit a segmented modified Poisson model using an interrupted time series design, adjusting for time-varying confounders. RESULTS We included 470 participants; 58% had predicted depressive symptoms at baseline. The median follow-up was 2.4 years (interquartile range [IQR]: 1.0-4.5.) pre-SVR and 1.4 years (IQR: 0.6-2.5) post-SVR. The pre-SVR trend suggested depressive symptoms changed little over time, with no immediate level change at SVR. However, post-SVR trends showed a reduction of 5% per year (risk ratio: 0.95 (95% confidence interval [CI]: .94-.96)) in the prevalence of depressive symptoms. CONCLUSIONS In the DAA era, predicted depressive symptoms declined over time following SVR. These improvements reflect possible changes in biological pathways and/or better general health. If such improvements in depression symptoms are durable, this provides an additional reason for treatment and early cure of HCV.
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Affiliation(s)
- Gayatri Marathe
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada,McGill University Health Center-Research Institute, Centre for Outcomes Research and Evaluation, Montreal, Quebec, Canada
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Marie-Josée Brouillette
- McGill University Health Center-Research Institute, Centre for Outcomes Research and Evaluation, Montreal, Quebec, Canada,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Charlotte Lanièce Delaunay
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada,McGill University Health Center-Research Institute, Centre for Outcomes Research and Evaluation, Montreal, Quebec, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada,McGill University Health Center-Research Institute, Centre for Outcomes Research and Evaluation, Montreal, Quebec, Canada
| | - Valérie Martel-Laferrière
- Département de microbiologie, infectiologie et immunologie, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Curtis Cooper
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Neora Pick
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | | | - Sharon Walmsley
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Marina B Klein
- Correspondence: M. B. Klein, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie Blvd, D02.4110, Montreal H4A 3J1, Canada ()
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Garrido-Estepa M, Herruzo R, Flores-Herrera J. Co-infections, comorbidities, and alcohol or other substances abuses in chronic hepatitis C-related hospitalisations in Spain. GASTROENTEROLOGIA Y HEPATOLOGIA 2022; 45:677-689. [DOI: 10.1016/j.gastrohep.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/08/2021] [Accepted: 01/14/2022] [Indexed: 11/26/2022]
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Khuhro Q, Shaikh H, Washdev, Hashmi S. Depression trends in Hepatitis-C PCR positive and PCR negative patients. Pak J Med Sci 2022; 38:162-166. [PMID: 35035419 PMCID: PMC8713198 DOI: 10.12669/pjms.38.1.4788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/12/2021] [Accepted: 08/28/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the frequency of depression in Hepatitis-C patients and its association clearance of HCV Methods: It is cross sectional study that was conducted between 1st July to 31st December, 2020, at National Institute of Liver and Gastrointestinal Diseases (NILGID),, Dow University of Health Sciences (DUHS).. Both male and female patients aged 18 to 60 years presenting with Hepatitis-C PCR positive or had received DAA for three months and became PCR negative were included in this cross sectional study. Depression was analyzed by Hamilton Depression Rating Scale (HDRS). Mean and standard deviations were calculated and analyzed. Results: Total 210 patients were included in this study, with mean age 36.06 ± 10.11 years. Depression was present in 118 (56.2%) patients. Among patients with HCV PCR positive depression present in 63 (30.0%) patients while in HCV PCR negative 55 (26.0%) patients. Similarly, depression in HCV PCR positive male patients, aged ≤40 years 80 (38.1%) and in HCV PCR negative 56 (26.7%) patients. Conclusion: Patients with chronic Hepatitis-C commonly suffer from depression. However, our study found no significant difference with change in PCR status at 12 weeks.
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Affiliation(s)
- Qutabuddin Khuhro
- Qutabuddin Khuhro, National Institute of Gastrointestinal Disease, Dow University Hospital, DUHS, Ojha Campus, Karachi, Pakistan
| | - Hafeezullah Shaikh
- Hafeezullah Shaikh, National Institute of Gastrointestinal Disease, Dow University Hospital, DUHS, Ojha Campus, Karachi, Pakistan
| | - Washdev
- Washdev, Institute of Behavioral Sciences, DUHS, Karachi, Pakistan
| | - Shahkamal Hashmi
- Shahkamal Hashmi, School of Public Health, DUHS, Karachi, Pakistan
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Serper M, Evon DM, Amador J, Stewart PW, Sarkar S, Lok AS, Sterling RK, Reeve BB, Golin CE, Reddy KR, Lim JK, Reau N, Nelson DR, Di Bisceglie AM, Fried MW. Patient-reported outcomes 12 months after hepatitis C treatment with direct-acting antivirals: Results from the PROP UP study. Liver Int 2021; 41:692-704. [PMID: 33387381 PMCID: PMC7969418 DOI: 10.1111/liv.14781] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/06/2020] [Accepted: 12/28/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS The long-term impact of hepatitis C virus (HCV) therapy with all-oral direct-acting antivirals (DAAs) on patient-reported outcomes (PROs) has not been well-described. We characterized changes in PROs from pre-treatment to 12 months post-treatment in a real-world cohort. METHODS PROP UP was a multi-centre observational cohort study of 1601 patients treated with DAAs at 11 US gastroenterology/hepatology practices from 2015 to 2017. PROs were evaluated pre-treatment (T1) and 12 months post-treatment (T5). A minimally important change (MIC) threshold was prespecified as >5% change in PRO scores from T1 to T5. Multivariable analyses identified predictors of change. RESULTS Three-quarters of patients were 55 or older; 45% were female, 60% were white, 33% were black, nearly half had cirrhosis. The most commonly-prescribed DAA regimens were sofosbuvir-based (83%) and grazoprevir/elbasvir (11%). Study retention was >95%. On average, small improvements were observed at 3 months post-treatment in all PROs and sustained at 12 months post-treatment among patients with sustained virologic response (SVR). Clinically meaningful improvements were achieved in fatigue (mean change score: -3.7 [-4.2, -3.1]), sleep (mean change score: -3.1 [-3.7, -2.5]), abdominal pain (mean change score: -2.6 [-3.3, -1.9]) and functional well-being (mean change score: -7.0 [-6.0, -8.0]). Symptom improvements were generally not sustained with no SVR (n = 52). Patients with cirrhosis and MELD ≥12 had the greatest improvements in functional well-being (-12.9 [-17.6, -8.1]). CONCLUSIONS The improvements in patient-reported outcomes reported by patients who achieved SVR following HCV DAA therapy were durable at 12 months post-treatment.
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Affiliation(s)
- Marina Serper
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Donna M. Evon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Jipcy Amador
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, United States
| | - Paul W. Stewart
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, United States
| | - Souvik Sarkar
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California at Davis, Davis, CA, United States
| | - Anna S. Lok
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Richard K. Sterling
- Division of Gastroenterology, Hepatology & Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Bryce B. Reeve
- Department of Population Health Sciences, Duke University, Durham, NC, United States
| | - Carol E. Golin
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, Department of Health Behaviors, University of North Carolina, Chapel Hill, NC, United States
| | - K. Rajender Reddy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Joseph K. Lim
- Digestive Diseases, Department of Internal Medicine, Yale University, New Haven, CT, United States
| | - Nancy Reau
- Department of Internal Medicine, Section of Hepatology, Rush University, Chicago, IL, United States
| | - David R. Nelson
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Adrian M. Di Bisceglie
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University, St. Louis, MO, United States
| | - Michael W. Fried
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
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Khalil MA, Shousha HI, El-Nahaas SM, Negm MI, Kamal K, Madbouly NM. Depression in patients with chronic hepatitis-C treated with direct-acting antivirals: A real-world prospective observational study. J Affect Disord 2021; 282:126-132. [PMID: 33412492 DOI: 10.1016/j.jad.2020.12.128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/07/2020] [Accepted: 12/24/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Direct-acting antiviral (DAAs) therapy showed high safety and efficacy profile in patients with chronic hepatitis C (CHC) particularly those with previous or current psychiatric illness. The aim of this study was to evaluate the incidence and potential risk factors of depression and psychological distress following DAAs therapy in CHC euthymic Egyptian patients with no previous or current diagnosis of any psychiatric disorders. METHODS This is a prospective study that included 126 patients diagnosed with chronic hepatitis C virus genotype-4. Patients were candidate for DAAs therapy and were recruited consecutively (convenient sample) from the viral hepatitis center, Department of Endemic medicine, Kasr Al-Ainy Hospitals, Cairo University. Symptom Checklist 90-R, Beck Depression Inventory (BDI) and Structured Clinical Interview for DSM-IV (SCID IV) were performed at baseline and at 12 weeks post-treatment with DAAs. RESULTS Forty-seven patients were included in the final analysis. Depression severity increased after treatment as BDI scores increased significantly than baseline scores (p= < 0.001). About one third of patients (32%) had moderate to severe depression. All Symptom Checklist-90 scores showed significant increase after treatment. LIMITATIONS Dropout rate of patients for the 12 weeks post-treatment assessment was 33.8%. CONCLUSION Depression and psychological distress can occur with DAAs treatments. Close psychosocial assessment and patient monitoring are still needed.
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Affiliation(s)
- Mohamed A Khalil
- Department of Psychiatry, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hend Ibrahim Shousha
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Saeed M El-Nahaas
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Pericot-Valverde I, Heo M, Niu J, Norton BL, Akiyama MJ, Agyemang L, Litwin AH. Declines in Depressive Symptoms Among People who Inject Drugs Treated With Direct-Acting Antivirals While on Opioid Agonist Therapy. Open Forum Infect Dis 2021; 7:ofaa380. [PMID: 33381611 PMCID: PMC7751182 DOI: 10.1093/ofid/ofaa380] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022] Open
Abstract
Background Hepatitis C virus (HCV) frequently co-occurs with symptoms of depression, which are aggravated on interferon-based regimens. However, it is unknown whether HCV treatment with direct-acting antivirals (DAAs) has effects on depressive symptoms among people who inject drugs (PWID). In this study, we examined changes in depressive symptoms during and after HCV treatment among PWID on opioid agonist therapies (OATs). Methods Participants were 141 PWID who achieved sustained viral response after on-site HCV treatment at 3 OAT programs. Depressive symptoms were assessed using the Beck Depression Inventory–II (BDI-II) at baseline, every 4 weeks during treatment, and 12 and 24 weeks after treatment completion. Current diagnosis of depression or other psychiatric diagnoses were obtained through chart review. Use of illicit drugs was measured by urine toxicology screening. Alcohol use was measured using the Addiction Severity Index–Lite. Results Of the 141 PWID infected with HCV, 24.1% had severe, 9.9% had moderate, 15.6% had mild, and 50.4% had minimal levels of depression as per BDI-II scores at baseline. HCV treatment was significantly associated with reductions in depressive symptoms that persisted long term, regardless of symptom severity (P < .001) or presence of depression (P ≤ .01) or other psychiatric diagnoses (P ≤ .01) at baseline. Concurrent drug use (P ≤ .001) or hazardous alcohol drinking (P ≤ .001) did not interfere with reductions in depressive symptoms. Conclusions Depressive symptoms are highly prevalent among HCV-infected PWID. HCV treatment was associated with sustained reductions in depressive symptoms. HCV therapy with DAAs may have important implications for PWID that go beyond HCV cure.
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Affiliation(s)
- Irene Pericot-Valverde
- Clemson University School of Health Research, Clemson, South Carolina, USA.,Department of Medicine, Prisma Health, Greenville, South Carolina, USA
| | - Moonseong Heo
- Department of Public Health Science, Health Sciences, Clemson University, Clemson, South Carolina, USA
| | - Jiajing Niu
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, South Carolina, USA
| | | | | | | | - Alain H Litwin
- Clemson University School of Health Research, Clemson, South Carolina, USA.,Department of Medicine, Prisma Health, Greenville, South Carolina, USA.,Department of Medicine, University of South Carolina School of Medicine-Greenville, Greenville, South Carolina, USA
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Mariño Z, Rodríguez-Tajes S, Bartrés C, Nácar L, Lens S, Navinés R, Cavero M, Londoño MC, Sastre L, Pocurull A, Dafieno A, Martín-Santos R, Forns X. Improvement of sexuality after hepatitis C cure with direct acting antivirals. Liver Int 2020; 40:2972-2977. [PMID: 33025664 DOI: 10.1111/liv.14689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/14/2020] [Accepted: 09/29/2020] [Indexed: 12/17/2022]
Abstract
Despite rarely assessed, sexuality is a relevant domain in Quality of Life. We prospectively evaluated the impact of direct-acting antiviral therapy on sexuality in a cohort of 186 patients with chronic hepatitis C (HCV). Sexual dysfunction was assessed by validated scales CSFQ-14/CSFQ-VAS at baseline and one year after treatment finalization. Median age was 55 years and 87% had mild liver disease. Basal prevalence of sexual dysfunction (62%) and fear of HCV transmission (25%) were high. After HCV cure, both sexual dysfunction prevalence and CSFQ-VAS improved (P = .058 and P < .01, respectively), and fear of HCV transmission dropped to 16% (P = .02). These changes were especially relevant in young men (<55), where sexual dysfunction decreased from 48.6% to 29.7% (P = .04) and among non-depressed patients in whom sexual dysfunction decreased from 54.6% to 47% (P < .01). Age and major depression remained as independent factors of sexual dysfunction persistence after HCV cure. Our data suggest that HCV eradication is associated with an improvement in sexuality, in those patients without depression.
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Affiliation(s)
- Zoe Mariño
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Sergio Rodríguez-Tajes
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Concepció Bartrés
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Loreto Nácar
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain.,Psychiatry and Psycology Department, Hospital Clínic Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Neurociencias, University of Barcelona, Barcelona, Spain
| | - Sabela Lens
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Ricard Navinés
- Psychiatry and Psycology Department, Hospital Clínic Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Neurociencias, University of Barcelona, Barcelona, Spain
| | - Myriam Cavero
- Psychiatry and Psycology Department, Hospital Clínic Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Neurociencias, University of Barcelona, Barcelona, Spain
| | - María C Londoño
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Lydia Sastre
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Anna Pocurull
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Angella Dafieno
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Rocío Martín-Santos
- Psychiatry and Psycology Department, Hospital Clínic Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Neurociencias, University of Barcelona, Barcelona, Spain
| | - Xavier Forns
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
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12
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Fabrazzo M, Zampino R, Vitrone M, Sampogna G, Del Gaudio L, Nunziata D, Agnese S, Santagata A, Durante-Mangoni E, Fiorillo A. Effects of Direct-Acting Antiviral Agents on the Mental Health of Patients with Chronic Hepatitis C: A Prospective Observational Study. Brain Sci 2020; 10:E483. [PMID: 32726940 PMCID: PMC7463817 DOI: 10.3390/brainsci10080483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/04/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023] Open
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.
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Affiliation(s)
- Michele Fabrazzo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Rosa Zampino
- Division of Internal Medicine, Unit of Infectious and Transplant Medicine, University of Campania “L. Vanvitelli”, AORN Ospedali dei Colli, Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; (R.Z.); (M.V.); (A.S.); (E.D.-M.)
- Internal Medicine, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Miraglia 1, 80138 Naples, Italy
| | - Martina Vitrone
- Division of Internal Medicine, Unit of Infectious and Transplant Medicine, University of Campania “L. Vanvitelli”, AORN Ospedali dei Colli, Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; (R.Z.); (M.V.); (A.S.); (E.D.-M.)
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Lucia Del Gaudio
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Daniela Nunziata
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Salvatore Agnese
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Anna Santagata
- Division of Internal Medicine, Unit of Infectious and Transplant Medicine, University of Campania “L. Vanvitelli”, AORN Ospedali dei Colli, Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; (R.Z.); (M.V.); (A.S.); (E.D.-M.)
| | - Emanuele Durante-Mangoni
- Division of Internal Medicine, Unit of Infectious and Transplant Medicine, University of Campania “L. Vanvitelli”, AORN Ospedali dei Colli, Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; (R.Z.); (M.V.); (A.S.); (E.D.-M.)
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
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