HIV-HCV
Coinfected Patients May Have Lower Prevalence of Psychiatric Comorbidities than
People with HCV Alone
By
Liz Highleyman Studies
have indicated that liver
fibrosis may progress faster in HIV-HCV
coinfected individuals than in HIV negative people with hepatitis
C virus (HCV) alone, making hepatitis
C treatment particularly urgent for this group. Some
medical providers, however, have been reluctant to treat coinfected patients --
especially injection drug users
-- due to a perceived higher risk of psychiatric side effects related to interferon-based
therapy. While some research has suggested that the risk of such side effects
is higher among individuals with pre-existing mental health conditions such as
depression and active substance use, data have not been consistent. As
reported at the XVII International AIDS Conference
this month in Mexico City, researchers undertook an investigation to compare clinical
characteristics of HIV-HCV coinfected and HCV monoinfected individuals starting
hepatitis C treatment with pegylated
interferon plus ribavirin, including prevalence of neuropsychiatric comorbidities. The
prospective analysis included 64 HCV treatment-naive patients (28 HIV-HCV coinfected,
36 with HCV alone) recruited from 4 New York City clinics between September 2006
and June 2008. Most participants (80%) were men and they were about evenly divided
among whites, blacks, and Hispanics. Participants
were assessed prior to initiating hepatitis C treatment using the Structured Clinical
Interview for DSM-IV Disorders (SCID), the clinician-administered Hamilton Depression
Scale (HAM-D), and the self-report Beck Depression Inventory (BDI-II). Results
•
Overall, HCV
monoinfected patients were significantly more likely to have current psychiatric
and substance use disorders compared with HIV-HCV coinfected patients.
•
47% of HCV
monoinfected patients met the SCID criteria for at least 1 current psychiatric
diagnosis, compared with 21% of coinfected patients (P = 0.03).
•
11% of HCV
monoinfected patients, but none of the coinfected patients, met the SCID criteria
for a current substance use diagnosis (P = 0.069).
•
HCV monoinfected
participants were about twice as depressed as coinfected patients according to
both clinician-administered and self-report scales (mean HAM-D 8.1 vs 4.6, P =
0.01; mean BDI-II 11.5 vs 6.1, P = 0.02).
•
While rates
of current comorbidities differed, the HCV monoinfected and HIV-HCV coinfected
patients did not differ significantly in their history of past psychiatric disorders
(58% vs 57%; P = 0.92).
•
The same was
true of past substance use diagnosis (86% vs 79%; P = 0.43) and history of injection
drug use (56% vs 64%; P = 0.48).
•
HCV monoinfected
and HIV-HCV coinfected individuals did not differ significantly in their likelihood
of receiving antidepressants, other psychotropic medications, or any psychiatric
treatment.
Based
on these findings, the investigators concluded, "The prevalence of psychiatric
comorbidity is higher among the HCV monoinfected than among HIV-HCV coinfected
patients at time of HCV treatment initiation." They
suggested that a potential explanation for this finding is that providers might
be using more stringent criteria when screening coinfected patients for HCV treatment.
Mount Sinai School of Medicine, New York, NY; Bronx Veterans Affairs
Medical Center, Bronx, NY.
8/26/08
Reference
J Weiss,
N Brau, D Dieterich, and D Fishbein. Higher prevalence of psychiatric comorbidity
at initiation of hepatitis C therapy in HCV monoinfected compared to HIV/HCV-coinfected
patients. XVII International AIDS Conference (AIDS 2008). Mexico City. August
3-8, 2008. Abstract WEPE0175. | 
