Patients with Depression prior to Hepatitis C Treatment Are Half as Likely to Achieve Sustained Virological Response

Depression is a common side effect among people taking pegylated interferon plus ribavirin to treat chronic hepatitis C. Depression may interfere with good adherence and leads some people to stop treatment prematurely.

As reported at the 47th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) this week in Chicago, researchers conducted a study to assess the effect of depression on sustained virological response (SVR), defined as undetectable HCV viral load 6 months after the end of treatment. They also looked at the effect of SVR on the development of depression.

The investigators performed a retrospective chart review of 694 hepatitis C patients treated with pegylated interferon (brand not specified) plus ribavirin at the University of New Mexico Health Sciences Center Hepatitis C clinic. The analysis included 108 patients who met the inclusion criteria.

All analyzed patients were being treated for the first time, were receiving full-dose pegylated interferon plus ribavirin, were not coinfected with HIV, and had 6 months of post-treatment follow-up. In this group, the mean age was 46 years, 60% were men, 55% were of Hispanic descent, and 63% had HCV genotype 1.

Information about demographics, HCV viral load, and the presence or absence of depression was extracted from patients' medical charts. The Center for Epidemiological Studies Depression Scale (CES-D) was used to determine the presence and development of depression. Multiple logistic regression analysis was performed to assess the relationship between SVR and depression.

Results

• 24% of the analyzed patients had depression at baseline.

• Among those not depressed at study entry, 41% developed depression during the course of treatment.

• Regression analysis showed that patients with baseline depression were less likely to achieve SVR.

• The odds of achieving SVR were 50% lower in depressed compared with non-depressed patients, after adjusting for patient demographics.

• Conversely, among those without depression at baseline, achievement of SVR was an important determinant in the development of depression.

• Individuals who achieved SVR had 27% lower risk of developing depression.

Conclusion

In conclusion, the investigators wrote, "The impact of depression is important for the clinician to assess when evaluating a patient's eligibility for HCV treatment as depression may diminish chances of optimal clinical response."

University of New Mexico Hospital, Albuquerque, NM.

09/18/07

Reference
R Cullen, N Khan, A Sanjeev, and others. Depression and Sustained Virologic Response in Hepatitis C Patients. 47th Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago, September 17-20, 2007. Abstract V-1898.