Hepatitis C - Impact of treatment with direct-acting antivirals on anxiety and depression

Impact of treatment with direct-acting antivirals on anxiety and depression in chronic hepatitis C 
Marta Gallach , Mercedes Vergara, Joao Pedro da Costa, Mireia Miquel, Meritxell Casas, Jordi Sanchez-Delgado, Blai Dalmau, Núria Rudi, Isabel Parra, Teresa Monllor, Meritxell Sanchez-Lloansí, Angelina Dosal, Oliver Valero, Xavier Calvet
Published: December 19, 2018 https://doi.org/10.1371/journal.pone.0208112

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Abstract
Background and aim
Treatment of hepatitis C with direct-acting antiviral agents (DAA) has few side effects. Although pivotal studies suggested that DAA were safe in patients with psychiatric diseases who could not be treated with previous antiviral therapies, their effects on anxiety and depression have not yet been analysed in clinical practice. The aim of our study was to analyse anxiety and depression in the setting of DAA treatment in a clinical practice series.

Methods
All patients starting DAA treatment between November 1, 2014 and October 31, 2015 were eligible. Patients completed the Hospital Anxiety and Depression scale at different times during treatment. The results were plotted on line graphs and evaluated using a linear regression model with repeated measures.

Results
One hundred and forty-five patients were included (11% with major psychiatric disorders; 32% on psychiatric treatment). Sustained virologic response (SVR) was achieved in 97.3% of cases. Anxiety and depression measures did not differ between time points. No differences between patients on psychiatric treatment or with advanced fibrosis or cirrhosis were found at any time point analysed.

Conclusion
DAA treatment had no impact on anxiety or depression during or after chronic hepatitis C infection treatment, even in high-risk patients with major psychiatric disorders.
Read More: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208112

Improvements in brain and behavior following eradication of hepatitis C

Update June 26, 2017
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The effect of SVR on the risk of extrahepatic manifestations of HCV infection
 Compared with HCV-infected individuals who did not receive treatment, SVR attainment was associated with a reduced risk of mixed cryoglobulinaemia, glomerulonephritis, porphyria cutanea tarda, non-Hodgkin's lymphoma, diabetes mellitus and stroke, but not lichen planus or coronary heart disease. Risk reductions were also observed when patients with SVR were compared with treated patients without SVR for mixed cryoglobulinaemia, glomerulonephritis, porphyria cutanea tarda and diabetes.
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Journal of NeuroVirology, Inc. 2017
First Online: 30 May 2017
Improvements in brain and behavior following eradication of hepatitis C
Taylor Kuhn1,2 & Philip Sayegh3 & Jacob D. Jones1,2 & Jason Smith2 & Manoj K. Sarma1 & A. Ragin1 & Elyse J. Singer4 & M. Albert Thomas1 & April D. Thames1 & Steven A. Castellon1,2 & Charles H. Hinkin1,2

Abstract
Despite recent advances in treatment, hepatitis C remains a significant public health problem. The hepatitis C virus(HCV) is known to infiltrate the brain, yet findings from studies on associated neurocognitive and neuropathological changes are mixed. Furthermore, it remains unclear if HCV eradication improves HCV-associated neurological compromise. This study examined the longitudinal relationship between neurocognitive and neurophysiologic markers among healthy HCV− controls and HCV+ adults following successful HCV eradication. We hypothesized that neurocognitive outcomes following treatment would be related to both improved cognition and white matter integrity. Participants included 57 HCV+ participants who successfully cleared the virus at the end of treatment (sustained virologic responders [SVRs]) and 22 HCV− controls. Participants underwent neuropsychological testing and, for a nested subset of participants, neuroimaging (diffusion tensor imaging) at baseline and 12 weeks following completion of HCV therapy. Contrary to expectation, group-level longitudinal analyses did not reveal significant improvement in neurocognitive performance in the SVRs compared to the control group. However, a subgroup of SVRs demonstrated a significant improvement in cognition relative to controls, which was related to improved white matter integrity. Indeed, neuroimaging data revealed beneficial effects associated with clearing the virus, particularly in the posterior corona radiata and the superior longitudinal fasciculus. Findings suggest that a subgroup of HCV+ patients experienced improvements in cognitive functioning following eradication of HCV, which appears related to positive changes in white matter integrity. Future research should examine whether any additional improvements in neurocognition and white matter integrity among SVRs occur with longer follow-up periods.

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Improvement of neurocognitive function in responders to an antiviral therapy for chronic hepatitis C

Improvement of neurocognitive function in responders to an antiviral therapy for chronic hepatitis C

1. Michael R Kraus^1,2,†,
2. Arne Schäfer^1,‡,*,
3. Gerlinde Teuber³,
4. Heiner Porst⁴,
5. Kathrin Paul³,
6. Sven Wollschläger⁴,
7. Christian Keicher¹,
8. Michael Scheurlen¹

DOI: 10.1002/hep.26229

Keywords:
hepatitis c;
interferon alfa;
neurocognitive performance;
long-term follow-up;
SVR – sustained virologic response

Abstract

Earlier studies have suggested neurocognitive impairment in patients with chronic hepatitis C virus (HCV) infection even before liver cirrhosis has developed. Since these deficits might be reversible after successful antiviral therapy, we analyzed the long-term course of neurocognitive parameters in HCV patients with and without successful virus elimination by an interferon-based antiviral treatment.

 

In a multicenter study including 168 HCV patients receiving antiviral therapy (peginterferon alfa-2b and ribavirin) we performed a long-term follow-up of neurocognitive performance before and after treatment.

 

Neurocognitive function was psychometrically assessed using the computer-aided TAP (Test Battery of Attentional Performance).

 

When tested at least 12 months after termination of antiviral treatment, patients with sustained virologic response (SVR) had improved significantly as compared to their pretreatment performance in three of five TAP subtasks (vigilance, P<0.001; shared attention – optical task, P<0.001; working memory, P<0.001).

 

Patients who failed to eradicate the virus, however, showed no significant long-term changes in neurocognitive performance in all five subtasks assessed (0.194 < P < 0.804).

 

In the post-treatment evaluation, neurocognitive function was significantly better in responders to the antiviral therapy as compared to non-responders.

 

Conclusion:

Successful eradication of HCV leads to a significant improvement of relevant aspects of attentional and neurocognitive performance, indicating that the neurocognitive impairment caused by chronic HCV infection is potentially reversible. This therefore suggests an added therapeutic benefit of antiviral treatment in HCV infection. Improvement of neurocognitive function may be an additional treatment indication in patients with HCV.

 

Source -  (HEPATOLOGY 2013.)