Does
Psychiatric Co-morbidity Predict Treatment Response in HIV-HCV Coinfected Patients
with a History of Injection Drug Use?
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that 25% of HIV-HCV coinfected patients in a Spanish study had concurrent psychiatric
conditions such as schizophrenia and affective disorders, and these were associated
with a lower rate of sustained response to interferon-based therapy, leading researchers
to recommend such that patients should be managed by multidisciplinary teams. |
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By
Liz Highleyman Due
to efficient transmission through shared needles and other equipment, many injection
drug users (IDUs) are coinfected with both
HIV and hepatitis C virus (HCV). In some groups of HIV positive IDUs, HCV
coinfection rates reach as high as 90%. Historically,
many clinicians have hesitated to treated active drug users for hepatitis C due
to concerns about inadequate adherence, poor tolerance of interferon side effects
such as depression, and high risk of reinfection due to continued needle-sharing.
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However,
a growing
body of evidence indicates that people on methadone maintenance, occasional
relapsers, and regular active drug users can
achieve good treatment outcomes if they receive appropriate support, especially
in an interdisciplinary setting that enables access to integrated services. While
the latest U.S. and European hepatitis C treatment guidelines have shifted away
from the previous blanket recommendation that substance users should be abstinent
for 6 months before starting anti-HCV
therapy, many questions remain regarding the best way to treat this population
-- even more so when considering those with HIV-HCV
coinfection. In
a poster presentation at the 5th International AIDS Society
Conference on HIV Pathogenesis, Treatment, and Prevention (IAS 2009) last
month in Cape Town, South Africa, Spanish researchers described a study they conducted
to determine factors that predict response to interferon-based therapy in a "real
world" setting outside of clinical trials, and to evaluate the influence
of psychiatric co-morbidities on hepatitis C treatment outcomes in a population
with a history of drug addiction. The
investigators looked at several potential confounding factors including patient
age, sex, CDC HIV/AIDS stage, CD4 cell count, use of antiretroviral
therapy (ART), HCV genotype, HCV RNA level, liver fibrosis grade as estimated
by FibroScan (non-invasive transient elastometry), and psychiatric co-morbidity. The
study included 114 HIV-HCV coinfected participants undergoing treatment with pegylated
interferon plus ribavirin, almost all (97.3%) of whom had a history of injection
drug use. The average age was about 40 years, 73% were receiving ART, the mean
CD4 cell count was 538 cells/mm3, and about 60% had hard-to-treat HCV genotypes
1 or 4. Results
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28% of the patients had some form of psychiatric comorbidity:
schizophrenia, shizotypal, and delusional disorders: 83%;
affective disorders: 38%;
neurotic disorders: 17%;
disorders of adult personality and behavior: 38%. |
| | 37%
had stage F1 (mild) fibrosis, 12% had stage F2 (moderate), 19% had stage F3 (advanced),
and 31% had stage F4 (cirrhosis). | | Overall,
41% of participants achieved sustained virological response (SVR), or continued
undetectable HCV RNA 24 weeks after completion of treatment. | | HCV
genotype 2 or 3 (P < 0.001), fibrosis grade lower than F2 (P = 0.002), and
lack of psychiatric co-morbidities (P = 0.026) were all significantly associated
with a higher likelihood of SVR. |
"Besides
HCV genotype and grade of fibrosis, the presence of psychiatric co-morbidity in
a population with antecedents of drug addiction is a predictive factor of lower
response," the investigators concluded. "It is necessary to form multidisciplinary
teams in the treatment of HCV in order to achieve similar response rates [as]
the population without problems of psychiatric co-morbidity and/or drug addiction."Txagorritxu
Hospital, Vitoria, Spain. 8/14/09 References
J
Portu, S San Miguel, G Arroita, and others. Predictive factors for achieving sustained
virological response under hepatitis C infection therapy. 5th International AIDS
Society Conference on HIV Pathogenesis, Treatment, and Prevention (IAS 2009).
July 19-22, 2009. Cape Town, South Africa. Abstract WEPEB222. (Abstract).
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