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Higher prevalence of psychiatric comorbidity at initiation of hepatitis C therapy in HCV-monoinfected compared to HIV/HCV-coinfected patients
J. Weiss1, N. Brau2, D. Dieterich2, D. Fishbein2
1Mount Sinai School of Medicine, Psychiatry, New York, United States, 2Mount Sinai School of Medicine, Medicine, New York, United States
Background: HIV/HCV co-infected persons are increasingly being treated for HCV infection, but there are still many barriers, in particular concerns about neuropsychiatric side effects. Providers are often hesitant to treat patients who have current substance use, psychiatric illness, and depressive symptoms. It is currently unknown, if the pretreatment prevalence of neuropsychiatric comorbidity is different between HIV/HCV-coinfected and HCV-monoinfected patients.
Methods: Forty HCV treatment-naïve subjects (17 HCV, 23 HIV/HCV) were recruited from four New York City clinics from September 2006- January 2008 for a prospective study investigating neuropsychiatric aspects of and adherence to HCV treatment. The subjects were assessed prior to initiating treatment with 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: The subjects were predominantly male (80%), from ethnic minorities (33% Hispanic, 32% black, 35% white), and 63% had a history of injection drug use with no differences between HCV-monoinfected and HIV/HCV-coinfected subjects. SCID criteria for at least one current psychiatric disorder were met by 11/17(65%) HCV-monoinfected and 6/23 (26%) of HIV/HCV-coinfected subjects (p=0.024). SCID Criteria for a current substance use disorder were met by 3/17 (18%) HCV-monoinfected compared to 0/23 (0%) of HIV/HCV-coinfected patients (p=.069). HCV-monoinfected subjects were more depressed than HIV/HCV-coinfected subjects on both clinician-administered [mean HAM-D, 9.3 vs. 5.2, p=.023] and self-reported scales [mean BDI-II, 13.7 vs. 7.0, p=.018].
Conclusions: In this interim analysis, the prevalence of psychiatric comorbidity was higher among HCV-monoinfected than among HIV/HCV-coinfected subjects. Potential explanations for this finding include (1) more stringent screening of HIV/HCV coinfected patients than HCV-monoinfected patients for HCV treatment and (2) greater access to comprehensive mental health services among HIV/HCV coinfected patients than among HCV-monoinfected patients. This study is ongoing and will provide more data that will then also allow subanalyses to explore these hypotheses.