Incidence of depression in patients with hepatitis C treated with direct-acting antivirals

Objective: Depression has been associated with hepatitis C, as well as with its treatment with proinflammatory cytokines (i.e., interferon). The new direct-acting antiviral agents (DAAs) have minimal adverse effects and high potency, with a direct inhibitory effect on non-structural viral proteins. We studied the incidence and associated factors of depression in a real-life prospective cohort of chronic hepatitis C patients treated with the new DAAs. Methods: The sample was recruited from a cohort of 91 patients with hepatitis C, of both sexes, with advanced level of fibrosis and no HIV coinfection, consecutively enrolled during a 6-month period for DAA treatment; those euthymic at baseline (n=54) were selected. All were evaluated through the depression module of the Patient Health Questionnaire (PHQ-9-DSM-IV), at three time points: baseline, 4 weeks, and end-of-treatment. Results: The cumulative incidence (95%CI) of major depression and any depressive disorder during DAA treatment was 13% (6.4-24.4) and 46.3% (33.7-59.4), respectively. No differences were observed between those patients with and without cirrhosis or ribavirin treatment (p > 0.05). Risk factors for incident major depression during DAA treatment included family depression (relative risk 9.1 [1.62-51.1]), substance use disorder (11.0 [1.7-73.5]), and baseline PHQ-9 score (2.1 [1.1-3.1]). Conclusions: The findings of this study highlight the importance of screening for new depression among patients receiving new DAAs, and identify potential associated risk factors.

Quality of life, risk behaviors and depression among carriers of hepatitis C virus and human T-cell lymphotropic virus type 1: a comparative study

Abstract Human T-cell lymphotropic virus type 1 (HTLV-1) has low prevalence rates, but is endemic in some regions of the world. It is usually a chronic asymptomatic infection, but it can be associated with serious neurologic and urinary conditions. Hepatitis C virus (HCV) is broadly spread out worldwide. The majority of these infections have a chronic course that may progress to cirrhosis and hepatocellular carcinoma. Objectives: To compare sociodemographic and mental health (risk behaviors, depression, and suicide) aspects, and quality of life among patients with HCV or HTLV-1. Methods: Observational, comparative and cross-sectional study involving outpatients with HCV or HLTV-1 infection. Sociodemographic characteristics, risk behaviors and quality of life were assessed through the questionnaires Mini International Neuropsychiatric Interview - MINI Plus (depression and suicide) and Medical Outcomes Study 36-Item Short-Form Health Survey (quality of life). Univariate and multivariate statistical analyses (hierarchical logistic regression) were conducted. Results: 143 individuals with HCV and 113 individuals with HTLV-1 infection were included. Males were predominant in the HCV group (68.8%) and females in the HTLV-1 group (71.7%). The frequency of risk behaviors (sexual and drug use) was greater in those with HCV (p < 0.05). A past depressive episode was more common in the HTLV-1 group (p = 0.037). Quality of life was significantly worse in the physical functioning, vitality, mental health, and social functioning domains in those with HTLV-1 (p < 0.05). HTLV-1 infection remained independently associated with worse quality of life in multivariate analysis. Conclusions: Risk behaviors are frequent among those infected with HCV. Additionally, despite HTLV-1 being considered an infection with low morbidity, issues related to mental health (depressive episode) and decreased quality of life are relevant.

O significado do acidente de trabalho com material biológico para os profissionais de enfermagem / El significado del accidente de trabajo con material biológico para los profesionales de enfermería / The significance of accidents involving biological material to nursing professionals

O objetivo deste estudo foi compreender o significado dos acidentes de trabalho com exposição a material biológico na perspectiva dos profissionais de enfermagem. De caráter exploratório com abordagem qualitativa pela análise de conteúdo de Bardin. No período de 2001 a 2006 ocorreram 87 acidentes com material biológico, sendo que destes, oito eram soropositivos para hepatite B e C e Síndrome da Imunodeficiência Adquirida/Vírus da Imunodeficiência Humana. Para coleta de dados utilizou-se entrevista com perguntas norteadoras. Ao indagar esses profissionais sobre o significado dos acidentes, emergiram quatro categorias: situação de risco; percepção de perigo; fatalidade e sentimentos. Embora não seja estratégia de esclarecimento, mas é fato que organização de trabalho e ações educativas tem impacto considerável para diminuir esse tipo de acidente, diminuindo prejuízos na vida dos acidentados.

El objetivo de este estudio ha sido comprender el significado de accidentes de trabajo con exposición a material biológico, desde la perspectiva de los profesionales de enfermería. De carácter exploratorio con enfoque cualitativo por el análisis de contenido de Bardin. En el período de 2001 a 2006 ocurrieron 87 accidentes con material biológico, de estos, ocho eran seropositivos para hepatitis B y C y Síndrome de la Inmunodeficiencia Adquirida/Virus de la Inmunodeficiencia Humana. Para recoger datos se ha utilizado entrevista con preguntas. Al preguntar a esos profesionales sobre el significado de los accidentes, han surgido cuatro categorías: situación de riesgo, percepción de peligro, fatalidad y sentimientos. Aunque no sea estrategia de aclaración, pero es un hecho que la organización de trabajo y acciones educativas tienen impacto considerable para disminuir ese tipo de accidente, disminuyendo perjuicios en la vida de los accidentados.

The objective of this present study was to understand the significance of occupational accidents with exposure to biological material from the perspective of nursing professionals. This study is exploratory with qualitative approach using Bardin's content analysis. 87 accidents involving biological material occurred in the period between 2001 and 2006, among them, eight were seropositive for hepatitis B and C and Acquired Immunodeficiency Syndrome/Human Immunodeficiency Virus. In order to collect data, it was used interview with oriented questions. When inquiring these professionals about the significance of these accidents, four categories emerged: risk situation, danger perception, fatality and feelings. Although it is not strategy of enlightenment, but it is fact that work organization and educative actions have considerable impact in order to reduce this type of accident, also reducing detriment to life of professionals who were involved in accidents.

Evaluation of the severity of depression and anxiety in hepatitis B and hepatitis C patients: a case control study

Although several studies have reported the poor mental health of patients with chronic viral hepatitis, few reports exists over the correlation of mental health and virus type. Current study was conducted to compare the severity of anxiety and depression in chronic hepatitis C, B and healthy subjects. This case control study was conducted in Tehran Hepatitis Center [THC] in 2006. Group I [chronic hepatitis C, n=14], group II [chronic hepatitis B, n=65] and group III [healthy subjects, n=65] were matched for age, sex and educational level and were compared by means of the severity of anxiety and depression measured by Hospital Anxiety Depression Scale [HADS]. The correlation between clinical or para-clinical findings of the patients with viral hepatitis and severity of anxiety and depression was also assessed. Group I in comparison to other groups reported a higher anxiety [9.57 +/- 3.86 vs. 7.45 +/- 4.52 vs. 4.81 +/- 4.80, p=0.001] and depression [6.43 +/- 3.76 vs. 5.23 +/- 3.74 vs. 4.76 +/- 4.40, p=0.05]. Anxiety and depression score were also both correlated with total serum bilirubin level, but were not correlated with other para-clinical findings. However the patients who had received interferon reported higher depressive symptoms but the difference did not reach statistically significant level. According to the higher severity of anxiety and depression in the case of chronic HCV infection in comparison to HBV infection or healthy subjects and the importance of mental health issues in viral hepatitis, we recommend a more close mental health observation in patients affected with HCV infection. Psychiatrist and psychologist visits and consultations can help in this approach