Depression does not influence hepatitis C
treatment outcomes in people co-infected with HIV, according to the results
of a small study conducted in Brighton and presented to the recent European Association for the Study of the Liver (EASL) conference,
HIV and the Liver.
However, the investigators from the Royal
Sussex County Hospital caution their results are only preliminary and need to
be tested in a larger patient cohort.
Pegylated interferon and ribavirin are the
backbone of current treatment regimes for hepatitis C infection. This therapy
is associated with a high rate of depression, which often lead to the
discontinuation of treatment. It is therefore recommended that patients should
be screened for symptoms of depression before initiating therapy for hepatitis
C, and prophylactic antidepressant treatment should be considered for people
with existing depression. Antidepressant treatment and psychological support
should also be offered to people who develop depression when taking
anti-hepatitis C drugs.
The impact of depression and antidepressant
therapy on treatment outcomes in people co-infected with HIV and hepatitis C
is unclear. Doctors in Brighton therefore designed a prospective study involving
38 people who were about to start treatment with pegylated interferon and
ribavirin. Their aim was to see if depression at baseline or during treatment
All the participants received hepatitis C
therapy lasting 24 weeks. An end-of-treatment response was an undetectable
hepatitis C viral load at week 24. A sustained virological response – or cure –
was an undetectable hepatitis C 24 weeks after the completion of treatment.
Most of the participants (n = 36; 95%) were men
and their mean age was 41 years. Injecting drug use was the main mode of
hepatitis C transmission (n = 35; 92%). Almost two-thirds (n = 23; 61%) were
infected with the harder-to-treat hepatitis C genotypes (1 and 4).
Before starting hepatitis C therapy, all the
participants were assessed for depression using the Structured Clinical Interview
for DSMIV and the Hamilton Depression Rating Scale. Three participants (8%) were
diagnosed with major depression using these assessment tools.
Some 32 participants were diagnosed with
depression after starting hepatitis C treatment and 17 (46%) received therapy
The participants did well on hepatitis C
therapy. An end-of-treatment response was achieved by 36 individuals (95%) and
a sustained virological response by 32 people (87%).
All three participants with depression at
baseline had both an end-of-treatment and a sustained virological response.
The emergence of depression during
treatment did not influence treatment outcomes. Antidepressant therapy had no
impact on outcomes in the patients who did become depressed.
“No significant influence was found for
depressive disorder at baseline or emerging during treatment on viral
response,” comment the investigators. “Antidepressant exposure did not appear
to influence viral response.”
They call for further research to validate
their findings. Nevertheless, the investigators believe their results support
the “management of depressive disorder during interferon alpha plus ribavirin
treatment. This will reduce depression associated interferon treatment dropout.”