Past Psychiatric Disorders Do Not Reduce Hepatitis C Treatment Effectiveness in Genotype 2/3 Patients

Some clinicians are reluctant to treat chronic hepatitis C patients with a history of psychiatric disorders because such individuals are believed to be more prone to poor adherence and severe neuropsychiatric side effects -- such as depression -- caused by interferon.

As reported at the 42nd Annual Meeting of the European Association for the Study of the Liver this month in Barcelona, French researchers presented data from the multicenter prospective, observational CHEOBS study, which was designed to evaluate adherence to pegylated interferon alfa-2b (PegIntron) plus ribavirin in patients with chronic HCV infection.

In the sub-analysis presented, the investigators assessed the impact of past psychiatric disorders on treatment adherence and sustained virological response (SVR) in patients with genotype 2 or 3 HCV. Among the total 2000 patients enrolled between January 2003 and December 2004, 702 had genotype 2 or 3. Of the 641 subjects in this group with sufficient data, 181 had a history of past psychiatric disorders, while 460 did not. Such disorders were defined as:

• Depression (n = 169; 93%);
• Attempted suicide (n = 49; 27%);
• Psychiatric hospitalization (n = 58; 32%). 

Results

• At baseline, the 2 groups did not differ significantly with regard to most socio-demographic, virological, and histological characteristics.
• However, unemployment (30% vs 12%), indebtedness (11% vs 4%), lower education level (67% vs 58%), former drug abuse (66% vs 42%), current psychiatric disorders (64% vs 8%), and infection with HCV genotype 3 (82% vs 66%) were significantly more frequent in patients with a psychiatric history.
• Current psychiatric disorders were depression (63%), anxiety (53%), chronic psychosis (6%), bipolar disorder (3%), and others (2%).
• Mean duration of hepatitis C therapy (28.4 vs 29.4 weeks), rate of early discontinuation of treatment (13% in both groups), and adherence at month 6 (54% vs 51%) did not differ significantly between patients with and without a history of past psychiatric disorders.
• The SVR rate was similar in the 2 groups (92% vs 83%, respectively).

Conclusion

The authors concluded that in a real-life setting, for patients infected with HCV genotype 2 or 3 treated with pegylated interferon plus ribavirin, past psychiatric disorders “were not a contraindication to HCV treatment,” nor were they a risk factor for non-adherence or lack of sustained virological response.

Centre Hospitalier Erstein, Erstein, France; Hopital General, Saint Dizier, France; Institut Arnaud Tzanck, Saint Laurent du Var, France; Hopital de Creteil, Creteil, France; Clinsearch, Bagneux, France; Centre de L’Appareil Digestif, Bourgoin Jallieu, France; Hopital Beaujon, Clichy, France; Hopital Pitie Salpetriere, Paris, France.

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