Long-term risk of depression and the impact of risk factors among chronic hepatitis C patients after successful antiviral therapy: A nationwide real-world Taiwanese cohort (T-COACH)

BACKGROUND: Chronic hepatitis C virus (HCV) infection is associated with an increased risk of neuropsychiatric disorders, including depression. However, the impact of interferon (IFN)-based therapy, after achieving a sustained virologic response (SVR), on the long-term risk of depressive disorders remains unclear. Thus, we evaluated the incidence of new-onset depression and the impact of risk factors on patients with chronic hepatitis C following antiviral therapy. METHODS: This nationwide, real-world cohort included a total of 5550 patients with HCV infection who received IFN-based therapy between 2003 and 2014. The primary outcome was the incidence of new-onset depressive disorder. The cumulative incidence of depressive disorders was analyzed using Gray's competing risk method, and Cox proportional hazards models were used to identify independent risk factors. RESULTS: During a mean follow-up of 4.07 years, the incidence of new-onset depression was 18.0 % in patients with SVR and 16.7 % in patients with non-SVR. Achieving SVR did not significantly reduce the risk of depression across the various subgroups. Multivariate analysis identified older age (≥45 years, HR = 1.32, 95 % CI: 1.10-1.57, P = 0.003) and female sex (HR = 1.29, 95 % CI: 1.11-1.49, P = 0.0007) as independent risk factors for depression, but only in patients with SVR. CONCLUSION: Our findings highlight the need for long-term psychiatric monitoring in patients with HCV infection after treatment, particularly in high-risk subgroups. Further studies involving direct-acting antiviral-treated cohorts with extended follow-up periods are required to validate these findings.