Canadian study finds hepatitis C cure leads to gradual improvement in symptoms of depression in people with HIV

• Chronic viral infections such as HIV and hepatitis C can cause depression
• Canadian researchers monitored 470 people co-infected with HIV and hepatitis C
• After hepatitis C was cured, researchers found that depression symptoms gradually lessened

Chronic hepatitis C virus (HCV) is relatively common among some subpopulations who are co-infected with HIV. HCV can be cured in more than 95% of people with the use of potent combinations of drugs such as the following:

• Epclusa – sofosbuvir + velpatasvir
• Maviret – glecaprevir + pibrentasvir

Chronic viral infections such as HCV and HIV can cause excess inflammation and activation of the immune system, both of which contribute to an increased risk for depression. Stress caused by stigma and discrimination as well as insufficient social and financial support can also contribute to depression risk. Additionally, Canadian researchers have noted that “ongoing substance use is a common additional risk factor [for depression].”

In people with chronic HCV alone (without HIV co-infection), being cured of HCV is associated with a reduction in symptoms of depression. However, there is limited research on whether cure of HCV has a similar impact in people who are co-infected with HIV.

In Canada

A team of researchers with the Canadian Coinfection Cohort reviewed health-related data from people with both HIV and HCV who were offered treatment between 2013 and 2020. Participants were from the following provinces:

• Alberta
• British Columbia
• Nova Scotia
• Ontario
• Quebec
• Saskatchewan

The researchers focused on 470 people who sought HCV treatment. Prior to initiating HCV treatment, 58% of these people had symptoms of depression. Researchers monitored participants for about two years prior to being cured and for just over a year after being cured.

Once participants were cured, there was no immediate change in their symptoms of depression. However, over the subsequent year, symptoms of depression gradually declined.

The researchers assessed their data to determine if other factors could have affected their findings—such as issues related to HIV (CD4+ cell count and viral load) or HCV (the degree of liver injury), use of alcohol and/or injection drugs, or recent incarceration. However, none of these issues had any significant impact.

Bear in mind

Although this was not a randomized trial, the results are aligned with other studies of people who were cured of HCV. A strength of the Canadian study is that researchers monitored people over several years, which can reveal trends over time. Another strength of the study was that participants were representative of co-infected people in Canada.

Screening and treatment of HCV is important, as curing HCV reduces the risk of serious complications, including hospitalization, liver failure and liver cancer. It also has another advantage: Once cured, a person is no longer capable of passing on this virus. This can help in the elimination of HCV as a public health issue.

The present study reveals yet another benefit—that successful treatment of HCV can lead to a remarkable improvement in mood. This undoubtedly would help improve health-related quality of life and is another reason to encourage people to get tested for HCV, and, if they have active infection, initiate HCV treatment.

—Sean R. Hosein

Resources

Hepatitis C testing and diagnosis – CATIE

Blueprint to inform hepatitis C elimination efforts in Canada — Canadian Network on Hepatitis C

Three Canadian provinces not on track to eliminate hepatitis C by 2030 – CATIE News

Hepatitis C key messages on transmission – CATIE

Harm Reduction Fundamentals: A toolkit for service providers — CATIE

Elimination of hepatitis by 2030 – World Health Organization

Canadian Liver Foundation

REFERENCES:

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3. Furman D, Campisi J, Verdin E, et al. Chronic inflammation in the etiology of disease across the life span. Nature Medicine. 2019 Dec;25(12):1822-1832. 
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5. Bertino G, Ragusa R, Corsaro LS, et al. Improvement of health-related quality of life and psychological well-being after HCV eradication with direct-acting antiviral agents. Real life setting data of an Italian cohort valued by Hepatitis Quality of Life Questionnaire (HQLQv2). Health Psychology Research. 2021 Jan 20;8(3):9450.  
6. Gormley MA, Akiyama MJ, Rennert L, et al. Changes in health-related quality of life for hepatitis C virus-infected people who inject drugs while on opioid agonist treatment following sustained virologic response. Clinical Infectious Diseases. 2022 May 3;74(9):1586-1593.