Depression rather than liver impairment reduces quality of life in patients with hepatitis C—LD Silva, et al
Source: Rev Bras Psiquiatr.
2015 Jan-Mar;37(1):21-30. doi: 10.1590/1516-4446-2014-1446
Results and Conclusion: In
the current study there were 124 patients (72 females; 52 males; mean
age 53 yo). The patients were given various clinical and psychiatric
evaluations. No patients were receiving HCV treatment. Various
in-person interviews were given to determine socio-economic information,
health-related quality of life, income, smoking, alcohol and drug
The study results found that
30.6% had major depressive disorder, which is consistent with other
studies. The degree of major depressive disorder and other psychiatric
disorders found in people with hepatitis C is associated with
health-related quality of life rather than tied to the degree of liver
fibrosis. The authors noted that more attention needs to be devoted to
“the implementation of integrated medical, psychiatric, and [that]
psychological care may be helpful.”
The Bottom Line: Up to 70% of people
with chronic hepatitis C have depressive disorders—this is a seven-fold
higher rate than the general population.
Editorial Comment: Does
HCV cause depression? Many experts believe that the hepatitis C virus
causes depression, but the exact mechanism hasn’t been completely
understood. There have been some studies that have shown that the
hepatitis C virus passes the blood-brain barrier and there have been
viral particles found in brain tissue. Another possible reason for
depressive disorders could potentially be the results of the immune
system cells fighting off the virus in brain tissue.
Regardless of what causes
depression in people with hepatitis C, it is clear that curing hepatitis
C also can increase the quality of life leading to a wide variety of
improvements in health including mental health. It’s time that we
recognize that we should treat everyone with hepatitis C regardless of
the degree of liver damage—hepatitis C is NOT just a liver disease.
Changes in characteristics of hepatitis C patients seen in a liver
center in the United States during the last decade—N Talaat et al.
Source: Journal of Viral Hepatitis Volume 22,Issue 5,
pages 481–488, May 2015
Results and Conclusion: This
was a retrospective study of the records of patients seen in liver
clinics 1998-1999 (Era-1) compared to the records of patients seen
The current study sought to
describe the characteristics of people with HCV who were newly referred
to liver clinics in Era-1 (538 patients). The records from Era-1
patients were compared to those of patients who were seen in Era-2 (810
patients). Advanced liver disease was defined as cirrhosis,
decompensated cirrhosis, or liver cancer.
The patients in Era-2 were older
(median age 56 vs 45 years), more likely to be Black (17.2% vs 11.6%)
and had a longer interval between diagnosis and referral (median 4
years vs 2 years). Genotype 1 was similar in both Era’s, but genotype
1a was 39.9% vs 53.8% in Era-2.
Even though there was a higher percentage of
treatment-experienced patients in the Era 2 patient group, the
comparison showed that more than three quarters of the patients had
never been treated.
Era-2 patients were more likely
to have advanced disease at referral (61.6% vs 51.5%)—with an
eightfold higher prevalence of HCC or liver cancer (21.6% vs 2.6%).
The Bottom Line:
The changes in the Era-2 patients points to important trends in the
hepatitis C population. These changes occurred over a relatively short
period of time:
The majority of patients identified had not been treated.
More patients had HCV
genotype 1a – generally a more difficult genotype/subtype to treat.
This also reflects a change in the demographics of the HCV population
of the United States.
The aging of the HCV population is reflective of more advanced disease including an eight-fold increase in liver cancer.
This study speaks volumes. In this short period of time there has
been a major advance in the rate of liver disease progression—most
notably the increase in liver cancer is frightening.
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