Report 17 from Dallas 50th AASLD Meeting, Nov 5-9

ANXIETY AND DEPRESSION IN CHRONIC HEPATITIS C - 
Jules Levin, NATAP

commentary: this study reports on depression in HCV but individuals with HIV also experience depression. So I think depression might be more of a problem for some individuals who have both HCV and HIV, and might be further added problem for those undergoing both HCV and HIV therapy. In addition study found higher rate of depression among those with history of IVDU, history of cocaine use, and people who had sex with IVDUs. Future HIV-HCV co-infection studies need to explore and characterize depression before and during HCV therapy. Specially designed support systems may be necessary because data below suggests depression may lead to therapy discontinuation. 

J Ong, N Boparai, C Speer, T Gramlich, M Kiwi, Z M Younossi, Cleveland Clin Fdn, Cleveland

Anxiety and depression are important issues for patients with chronic hepatitis C who may be candidates for interferon treatment. 

Aim: To evaluate the prevalence of depression and anxiety in patients with chronic hepatitis C and assess any Clinico-demographic and laboratory data that can be associated with this impairment. 

Design: Patients with established diagnosis of chronic hepatitis C and viremia were identified from our database (6/97-3/99). Clinico-demographics, established diagnoses of anxiety and depression and laboratory data were obtained from the database or patient interviews. Liver biopsies were re-read blindly by one heptopathologist using the modified HAI scoring system. 

Results: 150 patients agreed to participate (male 70%, W79%, AA 12%, Other 9%, Age 47±8). Of these, 50(34%) carried the diagnosis of depression and 14 (-%) had a history of anxiety. Depression/anxiety was diagnosis prior to interferon therapy in 57%, during interferon therapy in 37% and after interferon therapy in 6% of patients. In 23%,anxiety/depression prompted the discontinuation of interferon therapy. Additionally, 32% required treatment of depression/anxiety with medication alone, 7% with psychotherapy alone and 52 % with both medication and psychotherapy. Depression/anxiety was more common in those with history of IVDU (48% vs 27%, p=0.02),history of Cocaine use (54% vs. 34%; p=0.02) and those with a history of having sex with IVDU (52% vs 31%; p=0.03). Factors not related to depression/anxiety included: age, gender, ethnic background, level of education, current alcohol use, past alcohol use, HCV RNA, body mass index, histologic grade or stage of the liver biopsy. 

Conclusions: 1. In patients with chronic hepatitis C, history of anxiety and depression is common, mostly predating interferon therapy and requiring treatment. 2. Except for factors associated with high risk behavior, little other Clinico-demographic or laboratory factors are associated with this impairment.