Impaired Anger Control Is a Possible Side Effect of Hepatitis C Treatment in HIV-HCV Coinfected Patients

The standard of care for chronic hepatitis C virus (HCV) infection is combination therapy with pegylated interferon plus weight-based ribavirin for 24-48 weeks. Treatment leads to sustained response in about half of all patients -- with rates varying significantly based on HCV genotype – but also often produces difficult side effects.

Depression is a well-known adverse side effect of interferon-based therapy, and other types of neuro-psychiatric symptoms, such as anxiety, may also occur. In the January 2008 Journal of Clinical Gastroenterology, French researchers reported that impaired anger control may also be a side effect of interferon in HIV-HCV coinfected individuals.

The investigators set out to study the specific impact of hepatitis C treatment on anger expression and control in coinfected adult patients receiving antiretroviral therapy for HIV. In a cross-sectional survey in 2005, they collected both clinical and socio-behavioral data at 2 clinical centers in France.

Study participants were asked to complete an anonymous self-administered questionnaire covering socio-demographic, clinical, and behavioral characteristics, including self-reported treatment side effects, quality of life  (using the WHOQOL-HIV BREF survey), and irritability and anger (using the STAXI-2 survey).

Results

• Among the 139 patients on antiretroviral therapy at the time of the survey who had complete self-reported data, 24 were also being treated for hepatitis C using pegylated interferon, with or without ribavirin.

• Socio-demographic and clinical characteristics did not differ significantly between the interferon-treated and untreated 2 groups.

• Control of anger was significantly lower among interferon-treated patients than among untreated individuals (median STAXI-2 anger control-out dimension scores of 18.5 vs 23 respectively; P=0.02).

• Control of angry feelings was significantly correlated with psychological and social relationship dimensions of quality of life.

Conclusion

In conclusion, the investigators wrote, “Treatment of HCV-HIV coinfected patients may require closer monitoring for anger control issues and adjustment of treatment as appropriate.”

1/18/08