Treatment of hepatitis B and C co-infection in schizoaffective disorder

Abstract

Sir, Hepatitis B (HBV) and hepatitis C (HCV) are chronic viral liver infections representing a substantial health burden in the US and elsewhere.1 The impetus to ‘push the treatment envelope’ results in treatment of a patient group with co-morbid serious psychiatric illness that amplifies treatment challenges. We describe a HBV/HCV co-infected patient with cirrhosis and psychotic illness. A 39-year-old man was evaluated for cirrhosis and co-infection with HBV/HCV. The patient's other medical problems included prevailing psychiatric diagnoses of schizoaffective disorder and bipolar II disorder. He also had a history of substance abuse. Family history was significant for depression, including suicide in his father. He had no psychotic symptoms at the time of evaluation. Medications included lactulose, risperidone, quetiapine, gabapentin, bupropion, venlafaxine, and lorazepam. Physical examination revealed spider angiomata, gynecomastia, and testicular atrophy. HBV surface antigen and HCV antibody were positive. HCV genotype was identified as 2B, with a quantitative HCV-RNA of 1.6 million copies per ml. Liver biopsy confirmed cirrhosis. Hepatitis A antibody (total) was non-reactive, ALT 132 U/l, AST 82 U/l, INR 1.2, total bilirubin 1.1 mg/dl, WBC 2.7 K/mm3 and platelets 67 K/mm3. The Child-Turcotte-Pugh (CTP) score was 6–7 (Class A–B). His MELD score …