Small UK study suggests that depression does not have an impact on hepatitis C treatment outcomes in people co-infected with HIV

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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.

Glossary

depression

A mental health problem causing long-lasting low mood that interferes with everyday life.

prospective study

A type of longitudinal study in which people join the study and information is then collected on them for several weeks, months or years. 

pegylated interferon

Pegylated interferon, also known as peginterferon, is a chemically modified form of the standard interferon, sometimes used to treat hepatitis B and C. The difference between interferon and peginterferon is the PEG, which stands for a molecule called polyethylene glycol. The PEG does nothing to fight the virus. But by attaching it to the interferon (which does fight the virus), the interferon will stay in the blood much longer. 

interferon alfa

A natural protein produced by the human body in response to infection. Manufactured interferon alfa is a treatment against hepatitis B, hepatitis C, genital warts and some cancers. See also ‘pegylated interferon’ – this is the form of the most commonly used drug.

cure

To eliminate a disease or a condition in an individual, or to fully restore health. A cure for HIV infection is one of the ultimate long-term goals of research today. It refers to a strategy or strategies that would eliminate HIV from a person’s body, or permanently control the virus and render it unable to cause disease. A ‘sterilising’ cure would completely eliminate the virus. A ‘functional’ cure would suppress HIV viral load, keeping it below the level of detection without the use of ART. The virus would not be eliminated from the body but would be effectively controlled and prevented from causing any illness. 

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 influenced outcomes.

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 with antidepressants.  

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.”

References

Fialho R et al. The effect if depressive disorder on viral clearance in coinfected HIV/HCV patients undergoing interferon alpha treatment. EASL Monothematic Conference: HIV and the Liver, 2012.