Key result
DAAs in HCV are linked to improved depression and anxiety, especially with cryoglobulinemic vasculitis.
Why the study?
Limited information exists regarding the outcome of psychiatric disorders in HCV patients with and without cryoglobulinemic vasculitis after direct acting antiviral therapy.
Does direct acting antiviral therapy improve psychiatric outcomes in HCV patients with and without cryoglobulinemic vasculitis?
Cohort (n=76)
Open-label
No
Does direct acting antiviral therapy improve psychiatric outcomes in HCV patients with and without cryoglobulinemic vasculitis?
DAA therapy in HCV patients significantly improves depression and anxiety scores, particularly in those with cryoglobulinemic vasculitis.
Supports DAA psychiatric benefits in HCV; hypothesis-generating, needs RCTs before practice change.
OBJECTIVE: Hepatitis C virus (HCV) causes neuropsychiatric disorders and quality of life impairment, especially in patients with cryoglobulinemic vasculitis (CV). Direct acting antivirals (DAAs) are effective in most extrahepatic HCV diseases, but limited information exists regarding the outcome of psychiatric disorders in patients with and without CV, after therapy. We aimed to evaluate psychiatric outcomes, in HCV-patients with and without CV, before and after successful DAA therapy. METHODS: We prospectively studied DAA-treated HCV-patients, stratified into presence (CV) or absence of CV (NON-CV). Four psychometric scales were administered to assess depression (HAM-D and MADRS), anxiety (HAM-A), and mania (MRS). Short-Form-36 questionnaires evaluated quality of life. RESULTS: Seventy-six patients were recruited, and 47 CV and 29 NON-CV were treated with antivirals. At baseline, depression and anxiety, from mild to severe, were frequently shown, with the most advanced cases in thee CV group; no patients achieved the scores for mania. A significant improvement emerged for all the psychometric scales in the entire population and in the subgroups, after viral eradication even in the short-term outcome. The Short-Form-36 summary components showed benefits. CONCLUSIONS: After HCV eradication, the depression and anxiety scores significantly improved and severity grade generally lowered. DAA-positive effects on mental disorders should be considered part of the therapy outcome, being beneficial especially in CV patients who usually have worse baseline mental scores. Key Points • HCV frequently causes psychiatric disorders and an often-invalidating autoimmune/lymphoproliferative disease called cryoglobulinemic vasculitis. • The new direct acting antivirals (DAAs) are very effective and well tolerated by HCV-patients. • This study shows DAA-induced benefits on depression and anxiety in HCV-patients that are especially evident in CV patients who usually have worse baseline mental scores. • DAA-induced benefits are observed in the short-term post-therapy follow-up, in contrast with data previously obtained in HCV patients treated with IFN-based anti-HCV therapy.
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Gragnani et al. (2021) conducted a cohort in Hepatitis C virus (HCV) infection with and without cryoglobulinemic vasculitis (n=76). Direct-acting antivirals (DAAs) vs. Baseline (pre-treatment) was evaluated on Psychiatric outcomes (depression, anxiety, mania) assessed by psychometric scales (HAM-D, HAM-A, MADRS, MRS) from baseline to 12 weeks post-treatment. Direct-acting antiviral therapy significantly improved depression and anxiety scores in HCV patients after viral eradication, with benefits especially evident in patients with cryoglobulinemic vasculitis.
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