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Hepatitis C And Mental Health

Hcv Treatment Outcomes With Daa Therapy In Pwid

Impact of Hepatitis on Mental Health and Addiction Recovery

Despite the extensive overall data that have been generated with DAA-based therapies, only a moderate amount of data exists specific to the use of DAAs in persons with active injection drug use. The following summarizes several key studies that have analyzed HCV treatment responses with DAA-based therapy in persons who inject drugs or who have previously injected drugs and were receiving opioid agonist therapy. Multiple studies clearly show that use of DAA-based therapy in persons with past or current injection-drug use results in high SVR rates, comparable to those seen in persons who do not use drugs.

The Link Between Anxiety Depression And Hepatitis C

Mood changes, including anxiety and irritability, can come with a diagnosis of hepatitis C. You may feel anxious about the illness and your future when you learn youre at risk for liver cancer or other complications, says Camilla Graham, MD, an assistant professor of medicine at Harvard Medical School in Boston.

Depression can also be common, affecting anywhere from 20 to 50 percent of people who have hepatitis C, according to a review published in August 2021 in the World Journal of Gastroenterology.

There can be an unfortunate stigma attached to a hepatitis C diagnosis, especially when people dont understand the condition. A study published in November 2020 in the Journal of Viral Hepatitis found 95 percent of study participants reported experiencing some type of stigma related to their infection.

As a result, people with hepatitis C may become isolated, which can pave the way to depression, says Dr. Graham. Many people with hepatitis C become withdrawn and depressed, because they feel judged or shunned by others.

People with hepatitis C may also struggle with substance abuse today, the virus is often contracted through needles or other equipment used to inject drugs as well as the mental health issues that can go hand in hand with it, she says.

Potential Reinfection With Hcv Among Persons Who Inject Drugs

Multiple studies have shown significant risk of HCV reinfection in persons cured with HCV therapy. Thus, it is essential that persons with past or active injection-drug use be counseled that they can become reinfected with HCV after achieving an SVR. This risk is significant in persons who inject drugs, but reinfection can also occur through sexual contact, particularly among men who have sex with men. In one study that clearly evaluated reinfection among treated PWID, the reinfection rate for those reporting ongoing injection after SVR was 5.3/100 person-years. Similarly, in a recent systematic review of 36 studies of HCV reinfection following successful HCV treatment in persons who inject drugs, the overall rate of HCV reinfection was 6.2 per 100 person-years among those who reported recent injection-drug use. In a pilot study among 31 persons with active injection-drug use treated with ledipasvir-sofosbuvir, the reinfection rate was 16.3/100 person-years . Thus, it is important that programs for HCV treatment provide access to counseling for safe injection practices and opioid agonist therapy. Although unstudied, detailed guidance on safer injection techniques may mitigate the risk for HCV infection .

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Hcv Treatment In Persons Who Use Cannabis

There is mixed evidence regarding cannabis use and HCV-related hepatic fibrosis progression. Two separate longitudinal cohort studies found no association between cannabis use and progression of liver fibrosis among patients coinfected with HCV and HIV. In addition, one study found a positive association between cannabis use and good adherence with HCV treatment. Although individuals living with HCV are generally advised to abstain from regular cannabis use, ongoing cannabis use is not considered a contraindication for initiating HCV therapy.

Hcv Treatment Outcomes Among Persons With Alcohol Use

Hepatitis C Treatment Before or After Liver Transplant

Most of the studies that have addressed whether alcohol use impacts treatment outcomes were performed in the pre-DAA treatment era and results from these studies were mixed.

DAA Treatment Era

  • In the DAA treatment era, a large observational study out of the Veterans Affairs healthcare system evaluated the impact of alcohol use on HCV DAA-based treatment outcomes. Of the 15,151 persons who initiated DAA therapy and had a documented AUDIT-C score, 68.5% were categorized as abstinent, 22.6% as low-level drinking, and 8.9% as unhealthy drinking. Overall SVR12 rates were high among all persons in the study, regardless of alcohol use, with no statistical difference between HCV genotype or by cirrhosis status . These findings support current recommendations to not exclude persons from HCV treatment based on their alcohol use.

Interferon and Peginterferon Treatment Era

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Mental And Emotional Attitude

Keeping a positive mental attitude can be the single most important thing a person with hepatitis C does. This is more than just feeling happy. It is about actively constructing a positive outlook to combat negative thoughts.

Evidence suggests that people with chronic illnesses who maintain a positive outlook experience slower progression of their condition and respond better to treatment.

Of course, it can be difficult to stay positive. Everyone is different and some find it harder than others. This page has a few pointers to help you maintain a positive attitude.

Remember you are not your disease.

Initially, a diagnosis of hepatitis C can be overwhelming and affect your whole life as you spend time researching it and exploring your options. But defining yourself in terms of your disease is potentially very destructive.

It is key to remember that the qualities that have defined who you are throughout your life remain the same. You do not stop being a good parent or a good friend just because you have hepatitis C.

Things to do to stay positive:

  • Live in the present: Questions such as How did I get it? may prey on your mind, but ultimately they dont change your situation. Worrying about what you may have done will only lead to increasingly negative thoughts. Try to accept your present circumstances and embrace every new day.

The bad stuff

There are so many benefits to having a positive attitude, but it can still be difficult to embrace it.

Taking responsibility

Hcv Treatment Outcomes In Persons With Stimulant Use

One study examined the impact of past or active methamphetamine use in persons with chronic HCV treated with interferon-based regimens and methamphetamine use did not appear to significantly impact treatment completion or SVR rates. There are no published studies on the impact of methamphetamine use on DAA therapy.

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Mental Health And Hcv Infection

Injection drug use is the most common risk factor for HCV infection in most Western countries . CHC prevalence within PWID populations varies widely, but most studies found rates between 60% and 90% . Other psychiatric comorbidity are also significantly more prevalent in CHC patients than in the general population , especially in the group of PWID and in human immunodeficiency virus coinfected patients . Cognitive disturbances have also been reported in about one-third of CHC patients , with an additive effect of HIV/HCV coinfection .

Although comorbidity is related to increased high-risk behavior, such as injection drug use , there are other involved factors. Stigmatization and the fact that patients have to cope with a chronic infectious disorder can also increase the risk of depression and anxiety. Finally, a number of studies now support the hypothesis that HCV directly or indirectly induces biological changes in the central nervous system, which may result in psychiatric symptoms .

Impact Of Opioid Use And Hcv Treatment Adherence

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Multiple studies that have enrolled persons with active or recent injection-drug use have shown excellent adherence with DAA-based HCV therapy . Persons with opioid use disorder who receive opioid agonist maintenance therapy during HCV treatment have excellent rates of adherence, treatment completion, and sustained virologic response rates, all comparable to results of other study participants.

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Crude Recorded Prevalence Of Hcv

The crude recorded prevalence of HCV was 7.1% for patients with a diagnosis of schizophrenia and 8.1% among patients with a diagnosis of bipolar disorder. These were significantly greater than the observed recorded prevalence of HCV among the comparison group . As compared to those with a diagnosis of schizophrenia, those with a diagnosis of bipolar disorder were significantly more likely to have HCV .

Other characteristics significantly associated with a recorded diagnosis of HCV included being older than 40 years old, male, black or Hispanic, divorced or never married, homeless, living in an urban area, and having received a substance use diagnosis.

Adjusted Odds Ratios Of Reported Prevalence Of Hcv

The final model adjusted for age, race/ethnicity, gender, marital status, service connection, substance use, homelessness, region and locale and included an interaction term between substance use and the SMI diagnosis variable . Patients with a diagnosis of schizophrenia with a co-occurring substance use diagnosis had nearly 6 times the adjusted odds of a recorded diagnosis of HCV, compared to patients without both of these conditions. In contrast, patients with a diagnosis of schizophrenia without substance use diagnosis had approximately a 50% increase in the adjusted odds of a recorded diagnosis of HCV.

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Neuropsychiatric Adverse Effects Of Interferon Alfa And Ribavirin In Patients With Hcv

Neuropsychiatric side effects are common during interferon alfa and ribavirin therapy for HCV, ranging from 24% to 49% of patients experiencing such symptoms.47,107 Neuropsychiatric adverse effects can include fatigue, irritability, depression, anhedonia, relapse in alcohol or drug abuse, anxiety, anger, hostility, cognitive disturbances, manic symptoms, delirium, psychosis, and suicidal ideation.99,108111

During clinical trials conducted to gain US Food and Drug Administration approval of peginterferon alfa-2a and -2b, psychiatric adverse effects were among the most commonly reported adverse effects, occurring in 77% of patients.18 The most common psychiatric adverse effects were depression , irritability, and insomnia. The observance of high rates of insomnia and irritability in these early trials is interesting given that recent reports in the literature indicate that mania and hypomania are also common adverse effects of interferon alfa and ribavirin therapy for HCV.101,106,112,113 Suicidal ideation, suicide attempts, and actual suicides occurred in 2% of all patients studied during initial drug approval.114,115 Furthermore, psychiatric adverse effects have been among the most common reasons for therapy discontinuation, along with systemic and gastrointestinal effects.

Mental Health Management During Antiviral Treatment

Perceptions and Reality: Chronic Pain after Hepatitis C

The patient’s psychiatric condition should be monitored during IFN- therapy to early detect treatment-related changes . A reasonable schedule for general HCV patients would be monthly visits during the first 12 weeks of treatment, followed by visits at 8- to 12-week intervals thereafter until the end of therapy . However, in cases of psychiatric comorbidity or drug addiction, monitoring should be done every 24 weeks during the first 3 months, and then every 46 weeks until 1224 weeks after antiviral therapy . At each visit, patients should be questioned regarding the presence of side effects and depression. Psychiatric symptoms can be easily overlooked during routine clinical exams, as evidenced by a recent study which found that only 32% of patients who developed MDD during treatment were correctly identified as depressed by clinicians . Thus, increased education of both treating nurses/physicians and patients is necessary to allow improved early detection of psychiatric symptoms . Furthermore, the use of brief, validated screening tools is recommended, such as BDI , CES-D , PHQ-9 , HADS , or MDI . These scales can be used to monitor and quantify the severity of psychiatric symptoms. However, they are not diagnostic instruments, and a diagnosis of depression should be confirmed by an experienced mental health professional.

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Demographic And Clinical Characteristics

Patients with schizophrenia as well as patients with bipolar disorder were more likely to be younger, unmarried or divorced, homeless, black or Hispanic, to have a co-occurring substance use diagnosis, and to live in an urban area, as compared to patients without SMI diagnoses. Those with schizophrenia were significantly more likely to be male while those with bipolar disorder were significantly more likely to be female compared to patients without SMI diagnoses .

Psychosocial Experience Of Living With Hcv

In a narrative systematic review, Miller et al. identified 43 studies on this subject, all of which had been conducted in Western countries. HCV diagnosis was found to have deteriorating effects on social functioning in most of the studies. The authors also concluded that HCV was associated with social marginalization, impairment of intimate and family relationships, reduction in substance and alcohol abuse, changes in dietary intake, reduced sense of well-being due to fear of transmission and prognosis, fatigue, hopelessness, depression, anger, and stigma .

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Hepatitis C Treatment In A Co

Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Vic, Australia

Disease Elimination Program, Burnet Institute, Melbourne, Vic, Australia


Department of Gastroenterology, Alfred Health, Melbourne, Vic, Australia

Department of Medicine, Monash University, Melbourne, Vic, Australia

Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Vic, Australia

Disease Elimination Program, Burnet Institute, Melbourne, Vic, Australia

Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Vic, Australia

Disease Elimination Program, Burnet Institute, Melbourne, Vic, Australia

Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Vic, Australia

Disease Elimination Program, Burnet Institute, Melbourne, Vic, Australia


Department of Gastroenterology, Alfred Health, Melbourne, Vic, Australia

Department of Medicine, Monash University, Melbourne, Vic, Australia

Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Vic, Australia

Disease Elimination Program, Burnet Institute, Melbourne, Vic, Australia

Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Vic, Australia

Disease Elimination Program, Burnet Institute, Melbourne, Vic, Australia

Coping With The Mental Aspects Of Hepatitis C

Project HIP providing HIV/HEP C patients with free services

Depression and anxiety are common in people who have hepatitis C. Seeking social support and treating the virus with new medications can improve your mental health and quality of life.

Living with the hepatitis C virus doesnt just take a toll on your liver. It can also affect your mental health.

People with hepatitis C have higher rates of mental health disorders compared with people in the general population, says Andrew J. Muir, MD, MHS, a professor of medicine and chief of the division of gastroenterology at Duke University School of Medicine in Durham, North Carolina.

Here are the psychological challenges you might face from having and being treated for hepatitis C and what you can do to feel better, both mentally and physically.

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How Manage Your Feelings

To help keep your anxiety and depression in check:

Look past your label. Youâre living with HCV, but it doesnât have to define you. Make a list of all the other roles you have, like parent, partner, or friend. That will help remind you that thereâs more to you than this illness.

Stop drinking alcohol and using drugs. These habits will cause serious damage to your liver. They can also make depression and anxiety worse. Practice ways to say no, and stay away from people who pressure you to partake.

Put your partner first. If youâre in a long-term relationship with one person, the risk that youâll pass HCV to them during sex is low. Still, some drugs youâre treated with can raise virus levels in your body. Talk to your doctor about safety steps you should take, then share them with your partner before youâre in the bedroom.

Practice safe sex. Latex condoms are the best way to prevent passing on HCV during sex. Youâll need to use them before sex with a new partner. Choose only water-based lubricants. Oil-based products can damage condoms. Donât brush or floss your teeth right before deep kisses or oral sex. It could make your gums bleed and raise your chances of infection.

Manage your worries. Get enough sleep and eat healthy food. It takes a lot of energy to keep tension in check. Work out when you can too. Exercise is a way to keep stress in check.

How Hepatitis C Treatments Can Help Improve Your Mental Health

Learning more about the high success rate of treatments for the virus may help you better cope with anxiety. Medication can now cure more than 90 percent of people with hepatitis C, according to the Centers for Disease Control and Prevention .

A study published in October 2018 in the journal PLoS One found that when people with hepatitis C took direct-acting antiviral medication, they were not only cured of hepatitis C but also experienced reduced anxiety and depression and an improvement in overall quality of life.

Its important to keep in mind that the new DAAs have some side effects but are far more tolerable than the older injections of interferon, Graham notes. People living with hepatitis C shouldnt be fearful of seeking treatment.

The side effects from antiviral medications tend to be mild and include nausea, fatigue, and insomnia. Keep in mind, too, that the treatment lasts only 8 to 12 weeks, so any side effects are likely temporary, she says.

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Impact Of Opioid Use On Natural History Of Hcv

Opioid use by injection is a major driver of HCV transmission, but opioid use itself, either orally or by injection, does not appear to speed progression of liver disease in persons with chronic HCV. Opioid analgesic use disorder is also a risk factor for HCV acquisition and transmission, particularly as some users transition from oral ingestion of prescribed opioids to illicit opioids, and potentially to higher risk modes of administration, such as injection.

Hcv And Its Epidemiology

Hepatitis C Awareness and Education

HCV is a neuropathic ribonucleic acid based virus from the Flaviviridae family .14 HCV has 6 different viral genotypes and possesses a very primitive enzymatic replication system that has an error rate of 1/100,000 .15 This high error rate along with the genetic heterogeneity of HCV may explain the inability of innate immunity to clear HCV in the majority of those infected. Chronicity of HCV infection occurs in about 75%85% of those infected. This primitive replication machinery helps explain the resistance of HCV to antiviral therapies and difficulties in developing a vaccine against HCV infection.

The HCV genotypes, which have about 65% genetic homology, are geographically distributed. Genotypes 1, 2, and 3 are most common in North America and the Far East .16 Type 4 is found mostly in the Middle East . Genotype 5 is predominately found in South Africa, while genotype 6 is found almost exclusively in Southeast Asia.16

Among US patients with HCV infection, approximately 70% have genotype 1, while genotypes 2 and 3 together account for the remaining 20%30% of US HCV patients.17 Although HCV genotypes do not correlate with disease severity, response rates to interferon alfabased therapies are substantially higher among patients infected with genotype 2 or 3 compared with patients infected with genotype 1 .17 Furthermore, patients infected with these more responsive HCV genotypes can be treated with a shorter course of interferon alfa and ribavirin therapy .18

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