[Hepatitis C in a psychiatric setting: A forgotten reservoir?]

Area of Science:

• Hepatology
• Infectious Diseases
• Psychiatry
• Public Health

Background:

• Hepatitis C virus (HCV) causes chronic liver disease, cirrhosis, and liver cancer, affecting 0.5-1% of the French population.
• New antiviral drugs offer a >95% cure rate, enabling WHO-led HCV elimination goals (90% incidence reduction, 65% mortality reduction).
• HCV elimination requires identifying and targeting hidden reservoirs beyond people who inject drugs (PWIDs).

Purpose of the Study:

• To highlight inpatient psychiatric populations as a potential hidden reservoir for HCV.
• To explore the prevalence, risk factors, and implications of HCV in psychiatric inpatients.
• To advocate for integrated screening, treatment, and care strategies within psychiatric settings for HCV elimination.

Main Methods:

• Review of international data on HCV prevalence in European psychiatric inpatients.
• Discussion of potential risk factors, including history of drug use and institutional factors.
• Analysis of HCV's neural tropism and its impact on psychiatric symptoms and cognitive function.

Main Results:

• Chronic HCV infection affects approximately 5% of European psychiatric inpatients, a significantly higher prevalence than the general population.
• High prevalence may be linked to co-occurring psychiatric disorders and history of PWID, but other transmission routes may exist.
• HCV can cause neuroinflammation, cognitive impairment, anxiety, and depression, suggesting treatment can improve psychiatric outcomes.

Conclusions:

• Psychiatric settings represent a potential hidden reservoir for HCV, necessitating specific public health interventions for elimination.
• Integrated screening, treatment, and professional training are vital, with general practitioners and hospital pharmacists playing key roles.
• Tailored care pathways and innovative funding models are required to achieve micro-elimination of HCV within psychiatric populations.