Hepatitis C Treatment Eligibility and Outcomes in Patients with Psychiatric Illness

Abstract

Purpose: This report describes the existing status of Hepatitis C Virus (HCV) treatment eligibility, utilization and outcomes in a large sample of patients with HCV and co-morbid psychiatric illness. This would serve as a first step toward the facilitation of HCV treatment in psychiatric populations. Methods: Our sample was derived from the sequential screening of all admissions (N = 3470) to an inpatient psychiatric service at a VA medical center from 1998 to 2002. HCV treatment evaluation and outcomes were tracked in 360 HCV (+) patients. The patient's primary psychiatric admission diagnoses included one of the following: substance use disorders (alcohol, cocaine, marijuana); anxiety disorders; affective disorders (depression, bipolar) or psychotic disorder (schizophrenia). Results: As illustrated in Figure 1, more than 2/3 of patients did not receive HCV treatment due to: non-adherence, active psychiatric symptoms and active substance use. Eleven percent died from HCV complications. Sustained virologic response (SVR) was achieved in 31% of those treated with interferon-α (IFN) and ribavirin (RBV). Patients with psychotic or anxiety disorders were less likely to achieve SVR (p < 0.002) and more likely to have neuropsychiatric adverse effects from IFN treatment (p < 0.004) when compared with patients with affective or substance use disorders. Conclusions: HCV infection in patients with psychiatric illness was associated with significant mortality. IFN-based therapy combined with RBV can be safely administered to patients with HCV and psychiatric illness. However, many patients with HCV and psychiatric illness were found ineligible for HCV treatment due to their psychiatric illness, and non-adherence to the evaluation process leading to HCV treatment was substantial. Our results highlight the need to develop better management and therapeutic approaches to engage, manage and successfully administer HCV treatments to patients with psychiatric illness. [figure 1]Figure