We investigated and compared the results of treating the chronic hepatitis C (HCV) infection of different groups of psychiatric-risk patients and controls with pegylated interferon alpha (pe-gIFN-␣) plus ribavirin. Seventy patients were prospectively screened for psychiatric disorders. Seventeen patients without psychiatric diseases or drug addiction (controls), 22 patients with psychiatric disorders, 18 patients who had received methadone substitution treatment and 13 patients who were former drug users were treated with pegIFN-␣ plus ribavirin. Sustained virological response (SVR), adherence, and psychiatric side effects (using the Montgomery-Asberg Depression Rating Scale and the Brief Psychiatric Rating Scale) in the groups were compared. An SVR was found in 58.6% of all patients: 58.8% of the controls, 50% of psychiatric patients, 72.2% of methadone patients, and 53.8% of former drug users. Methadone-substituted patients and former drug users had significantly higher dropout rates. Scores for neither depressive nor psychotic symptoms differed significantly between groups during treatment. However, the controls had lower pretreatment scores, followed by a significant higher increase to maximum scores. A stepwise logistic regression model showed that only genotype, not group (control, psychiatric, methadone, or former drug abuse), type of psychiatric diagnosis (affective disorder, personality disorder, or schizophrenic disorder), depression scores before and during treatment, change in depression score, antidepressive treatment, sex, or liver enzymes before treatment, was associated with SVR. Conclusion: In an interdisciplinary treatment setting psychiatric diseases and/or drug addiction did not negatively influence psychiatric tolerability of and antiviral response rate to HCV treatment with pegIFN-␣ and ribavirin. (HEPATOLOGY 2007;46:991-998.)
See Editorial on Page 957 I t is estimated that 170 million people worldwide are infected with the hepatitis C virus (HCV). Although the prevalence in the general population ranges between 1% and 2.4%, 1,2 the prevalence of HCV infection in patients with a chronic psychiatric disorder has been found to be significantly higher-between 6.8% and 8.5%. 3,4 Moreover, between 60% and 98% of intravenous drug users are chronically infected with HCV. [5][6][7] Interferon alpha (IFN-␣) is still the only effective treatment for chronic hepatitis C infection. In 1998, 2 studies showed that a combined regimen of IFN-␣ with ribavirin increased the sustained virological response (SVR) from 10% to 40%. 8,9 The development of pegylated interferons (pegIFN alpha-2a and pegIFN alpha-2b), characterized by a significantly longer half-life that allowed subcutaneous injection only once a week, further significantly improved therapeutic outcome when used in treatment in combination with ribavirin. [10][11][12] SVR rates between 51% and 82% have been reported, depending on the virus genotype. 10,11 Antiviral treatment of chronic hepatitis C with IFN-␣ is associated with several neuropsychiatric side effects such as fatigue, anhedonia, depression, irritability, cognitive disturbances, mania, psychotic symptoms, delirium syndromes, relapse in alcohol or drug abuse, and even suicidal thoughts. 13,14 Former or current drug abuse and Abbreviations: HCV, hepatitis C virus; IFN, interferon; SVR, sustained virological response.