Hepatitis C infection, antiviral treatment and mental health: A European expert consensus statement

Summary

Mental health problems frequently occur in chronic infection with the hepatitis C virus (HCV) and during antiviral treatment with pegylated interferon-alpha (PegIFNα) and ribavirin. Depression is one of the most important complications during antiviral treatment of chronic hepatitis C infection. However, an increased prevalence of depression, fatigue, and cognitive disturbances has also been reported in untreated HCV-positive patients. Patients with psychiatric disorders or drug addiction also have an increased risk of HCV infection. Furthermore, because of possible drug–drug interactions, new antivirals administered together with PegIFNα and ribavirin may complicate psychiatric side effect management, even if no specific psychiatric adverse events are known so far for these new drugs.

The European liver patient’s organization (ELPA) organised a European expert conference to review the literature and develop expert recommendations for the management of mental health problems in HCV infected patients.

This paper results from the output of the 2011 EASL meeting and subsequent dialogue with patient groups and relevant experts in Europe. It summarises the current knowledge of HCV infection and the brain; prevalence, course, and neurobiology of IFN-α associated psychiatric side effects; possible risk factors for IFN-α associated depression and suicide attempts; psychiatric management of HCV infected patients before and during antiviral treatment; prevention of IFN- α associated psychiatric side effects; and psychiatric aspects of the new antivirals.

The summarised current knowledge about mental health changes before and during antiviral treatment should improve interdisciplinary management of HCV infected patients.

Introduction

An estimated 170 million people are infected with the hepatitis C virus (HCV) worldwide. HCV infection is the most frequent cause of chronic hepatitis and an important risk factor for liver cirrhosis and hepatocellular carcinoma. There is an increased prevalence of psychiatric co-morbidity in patients with chronic HCV infection and emerging evidence suggests that mental health problems may be associated with the infection itself, possibly mediated by an effect on the central nervous system (CNS). In addition, antiviral combination therapy with PegIFNα and ribavirin is often associated with significant psychiatric side effects, such as depression, fatigue, insomnia, anxiety, cognitive disturbances [1], [2] or suicide attempts, which represent the worst possible complication of severe depressive syndromes [3]. Mental health problems during antiviral treatment have a strong impact on quality of life, may reduce treatment compliance and are risk factors for treatment failure [4], [5], [6]. Research over recent years has sought to increase knowledge about the frequency, course, and pathophysiology of mental health problems during chronic HCV infection and antiviral therapy with PegIFNα and ribavirin. Different management strategies for the acute treatment or for the prevention of psychiatric problems have been developed to avoid dose reduction or treatment discontinuation. However, to date there has not been an international, interdisciplinary consensus regarding the current knowledge of mental health problems during HCV infection and treatment-related psychiatric problems. At the 2011 EASL meeting, the European liver patient’s organization (ELPA) initiated a European expert consensus conference to review the current available scientific data on HCV and treatment-related psychiatric effects, in order to produce recommendations for the psychiatric management of patients before, during and after hepatitis C treatment.