High Seroprevalence of Hepatitis C Virus Among Australian Psychiatric Inpatients: A Multicentre Study of Seroprevalence, Risk Factors and Treatment Experience

Background and aims: Treatment of hepatitis C virus (HCV) in patients with mental illness was previously hampered by the adverse neuropsychiatric effects of interferon therapy. The new era of directly acting antiviral (DAA) therapy has renewed interest in HCV treatment in this population due to its improved safety profile. The aims of this study were therefore to assess HCV prevalence and risk factors in psychiatric inpatients and to explore treatment models of care. Methods: This prospective study involved patients admitted to four inpatient psychiatric units, from December 2016 to December 2017. After consent HCV testing was performed, and information about HCV risk factors was obtained. Results: Two hundred and sixty patients (70% male), median age 44 years (IQR 24) participated in the study. The period prevalence of HCV antibody was 10·8% (95% CI 7-15). 80% of the study cohort had at least one risk factor for HCV. Independent predictors of HCV positive status were injection drug use (p<0·001, OR 44·05, 95% CI 7·9-245·5), exposure to custodial stay (p=0·011, OR 7·34, 95%CI 1·6-33·9), and age (p=0·011, OR 1·09, 95%CI 1·02-1·16). Of the 28 seropositive patients, 16 were HCV RNA positive. Eight of them were initiated on DAAs. Hepatitis nurses liaised with community mental health teams for treatment initiation. Six patients achieved sustained viral response, one achieved end of treatment response, and results are awaited in one. The remaining eight patients have proven difficult to engage with. Conclusion: HCV prevalence was high in this multicentric study cohort of psychiatric inpatients. Although treatment uptake was achieved only in 50% patients, it was successful in the majority. The findings highlight the urgent need to educate the mental health sector about the necessity to embed HCV screening practices and to build effective linkages for their patients to HCV treatment in the current DAA era. Funding: Unrestricted educational grant was received from Merck Sharp & Dohme (Australia) Pty Ltd (MSD), 2017 for this study. The funding agency had no role in the study design, execution or write- up. Conflict of interest: None Ethics approval: The project was approved by the Southern Adelaide Clinical Human Research Ethics committee (OFR #291.16 – HREC/16/SAC/232)