Depressive disorders in HIV-HCV patients undergoing interferon-a treatment for hepatitis C

Effective clearance rates of HCV with interferon alpha plus ribavirin treatment are reported to be reduced in the co-infected HIV/ HCV population when compared to the HCV monoinfected population [1]. Neuropsychiatric adverse events are associated with hepatitis C treatment and interferon alpha-induced major depressive disorder is commonly reported [2]. This study examined the rate and predictors of depression during interferon alpha plus ribavirin treatment in a Brighton, UK cohort of HCV-infected patients including a subsample with HIV coinfection. Depressive disorder was explored at baseline and monthly up to 6 months using the Structured Clinical Interview for DSMIV and the Hamilton Rating Scale for depression. Six month treatment response was determined using viral load assay (clearance achieved if HCV RNAB400 IU/mL). A cohort of 237 HCV patients consented to participate in the study, including 38 coinfected with HIV. The HCV monoinfected group had a mean age of 45.60 years (SD 8.93) and 64.3% were male. The HIV/HCV coinfected group had a mean age of 41.34 (SD 9.8) and 94.7% were male. The most common mode of HCV transmission was intravenous drug use in both groups. Notably, clearance rates at 6 months were equivalent in both groups: 88.3% in the HCV group vs 86.5% in the coinfected group. Baseline DSMIV depressive disorder rates and mean HAMD scores were not significantly different between groups. For Hamilton depression scores over time, a significant multivariate effect was found [Wilks’ Lambda .33, F (6, 203) 67.73, pB.001, hp2 .67] with the co-infected group having lower scores. For the whole sample, post-hoc comparisons revealed that all depression scores after week 8 were significantly different from baseline scores and scores at week 4. Multiple regression analysis revealed DSMIV depressive disorder at week 4 was significantly predicted by baseline DSMIV depression (b .30), past psychiatric history (b .25), and not being coinfected (b .16). Age and gender had no significant effect. Only baseline depression predicted depression at later time points. Lower rates of depression in this coinfected group may relate to antiretroviral treatment effects. Limitations of our study include a small coinfected sample size and the absence of immunological data over the time course.