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Can successful treatment by direct-acting antivirals improve depression in chronic HCV patients?
Amal Tohamy Abdel Moez1, Yomna Ahmed El Hawary2, Amira Mahmoud Al Balakosy1
1Tropical Medicine Department, Faculty of Medicine.
Insights
Direct-acting antivirals (DAAs) significantly improve depression in chronic hepatitis C (CHCV) patients by clearing the virus. However, persistent depression may occur in older females with significant fibrosis and low hemoglobin.
Area of Science:
- Hepatology
- Neuropsychiatry
- Virology
Background:
- Depression is a common neuropsychiatric issue in chronic hepatitis C (CHCV) patients.
- Neuropathogenic mechanisms are believed to cause depression in CHCV.
- Direct-acting antivirals (DAAs) offer a potential treatment for viral clearance and associated symptoms.
Purpose of the Study:
- To assess the impact of viral clearance achieved through DAAs on depression levels in CHCV patients.
- To evaluate the efficacy of DAAs in mitigating depression in the context of hepatitis C treatment.
Main Methods:
- 150 CHCV patients eligible for DAAs were enrolled.
- The Beck Depression Inventory (BDI) scale was used to assess depression at baseline, 1 month, and 3 months post-treatment.
- Sustained virological response (SVR) was confirmed for all patients.
Main Results:
- A significant decrease in BDI scores was observed post-treatment (from 10 ± 5 at baseline to 5.3 ± 5 at 1 month and 3.5 ± 4.5 at 3 months).
- 13.3% of patients maintained a BDI score >10 post-treatment.
- Persistent high depression scores were associated with older age, female gender, higher baseline FIB4 scores, significant fibrosis, and lower baseline hemoglobin.
Conclusions:
- Successful DAA treatment leads to significant improvement in depression associated with CHCV.
- Depression may persist in specific subgroups, including elderly females with significant fibrosis and low hemoglobin.
- Further research may be needed to address persistent depression in these patient populations.
Background:
Depression is the most common extrahepatic neuropsychiatric manifestation in chronic hepatitis C (CHCV) and is due to direct neuropathogenic mechanisms. Our aim is to evaluate the effect of viral clearance by directly acting antivirals (DAAs) on depression in CHCV patients.
Methods:
One hundred fifty chronic HCV patients eligible for DAAs were assessed for depression using the Beck depression inventory (BDI) scale at baseline, 1 and 3 months after end of treatment (EOT). BDI ≥10 reliable in detecting depression in CHCV.
Results:
All included patients received Sofosbuvir/Dacltasvir ± Ribavirin for 12 weeks and all achieved sustained virological response (SVR). Baseline BDI of all included patients was 10 ± 5 then decreased to 5.3 ± 5 and 3.5 ± 4.5 at 1 and 3 months after EOT (P = 0.001), respectively. After EOT, 20 patients (13.3%) had BDI >10 which were 11.35 ± 6.5 and 13.3 ± 3.2 at 1 and 3 months (SVR), respectively. A comparison between patients with high and low BDI after EOT showed that patients with persistent high score were older (60.6 ± 9.5vs 52.2 ± 10.6, P = 0.001) and included higher percentage of females (50% vs 22.3%, P = 0.01). Also high BDI patients had higher baseline FIB4 (3 ± 1.6 vs 2 ± 1.3, P = 0.006) and included more patients with significant fibrosis (40% vs 17.7%, P = 0.05), as well as lower baseline hemoglobin (13.6 ± 1.5 vs 14.4 ± 1.65, P = 0.04).
Conclusion:
Depression associated with CHCV improves after successful treatment with DAAs; however, it may persist in elderly females with significant fibrosis and low hemoglobin.
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