- Researchers assessed data from 12,722 people for exposure to viral hepatitis and other factors
- People who have had hepatitis B or C were more likely to be using antipsychotic medication
- This correlation does not imply causation, but can help identify hepatitis screening candidates
The World Health Organization (WHO) is encouraging countries and regions to help eliminate viral hepatitis—mainly hepatitis B virus (HBV) and hepatitis C virus (HCV)—as a public health issue by the year 2030. To realize this goal, more opportunities for testing need to be made available, particularly for people at high risk for these infections. In many cases, treatment for HBV can help control this virus and reduce the risk of severe liver injury. Treatment for HCV can cure 95% of cases.
A team of researchers at the University of Toronto Dalla Lana School of Public Health has analysed health-related information collected in the U.S. with a focus on viral hepatitis. The researchers reviewed information from more than 12,000 people—a representative sample of the U.S. population (not including incarcerated people). The researchers found that people who tested positive for certain antibodies to HBV or for HCV were several-times more likely to have a recent prescription (in the past 30 days) for at least one antipsychotic medicine compared to people who did not have these antibodies.
Readers should not assume that many or most people with viral hepatitis have psychosis or use antipsychotic medicines. The reasons for this will be explained below.
Although there were 12,722 people whose data were analysed by the researchers, only 1.1% had a recent prescription for antipsychotic medication. While a very small proportion of people were using these medications, their overall risk for viral hepatitis was greater than that of people who did not use these drugs.
Doctors sometimes prescribe antipsychotics for people with conditions other than psychosis. Once a drug is approved for one condition by regulatory authorities, doctors may choose to prescribe the drug for other conditions if in their assessment the drug can provide relief to the patient. For some of these other conditions, lower doses may be used than for the initially approved condition (psychosis). Some of the conditions for which antipsychotics are used include the following:
- bipolar disorder
- borderline personality disorder
- nausea and vomiting due to chemotherapy
- psychosis caused by street drugs
- sleeping problems
Therefore, not everyone prescribed these drugs has psychosis.
Associations with viral hepatitis
The researchers found that people who used antipsychotics were more likely to have the following factors:
- born in the U.S.
- have a low income
- have received a blood transfusion
- reported injecting drugs
The researchers focused on people between the ages of 20 and 59, as complete data were available on them. They stated that the link between viral hepatitis and the use of antipsychotic medicines “was most pronounced among individuals over the age of 40.”
Once the researchers considered factors such as a history of blood transfusion, alcohol use, injection drug use, sexual behaviour and other issues such as socioeconomic status, they did not find that major mental illness by itself was a risk factor for viral hepatitis. Also, based on this analysis, the use of antipsychotics by themselves was not a risk factor for viral hepatitis, as the virus is transmitted via certain risk factors.
Focus on HCV
As mentioned earlier, people who are treated for HCV have high rates of cure. To eradicate HCV as a public health issue, enhanced opportunities for testing need to be made available. Based on their results, the University of Toronto researchers stated that healthcare providers may find it useful to review prior prescriptions of their patients in case some have used antipsychotics in the past. This could then lead to a discussion about HCV screening.
Furthermore, the researchers also stated that measures to prevent blood-borne infections (viral hepatitis, HIV and so on) should be integrated into “mental health care for people with major mental illness and those with prescriptions for antipsychotic drugs.”
The researchers accessed anonymous data collected from a study called NHANES (National Health and Nutrition Examination Survey). They analysed data collected between 2005 and 2014. According to the researchers, “NHANES includes self-reported demographic, socioeconomic, and health-related information from a questionnaire, as well as medical, physiological, and laboratory measurements.” They also noted that “responses to NHANES questions on sociodemographic factors, alcohol, drug use and sexual behaviour are self-reported, and some degree of misclassification is likely.”
You can find out more about NHANES here.
—Sean R. Hosein
Blueprint to inform hepatitis C elimination efforts in Canada — Canadian Network on Hepatitis C
Hepatitis B – CATIE
Elimination of hepatitis by 2030 – World Health Organization
- Awan A, Shakik S, Banack HR, et al. Hepatitis B and C in individuals with a history of antipsychotic medication use: a population-based evaluation. PLoS One. 2023 Apr 14;18(4): e0284323.
- Polaris Observatory HCV Collaborators. Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study. Lancet Gastroenterology and Hepatology. 2022 May;7(5):396-415.
- Corona-Mata D, Rivero-Juarez A. The road to HIV and HCV elimination among people who inject drugs. Lancet Gastroenterology and Hepatology. 2023 Jun;8(6):497-498.
- St-Jean M, Tafessu H, Closson K, et al. The syndemic effect of HIV/HCV co-infection and mental health disorders on acute care hospitalization rate among people living with HIV/AIDS: a population-based retrospective cohort study. Canadian Journal of Public Health. 2019 Dec;110(6):779-791.
- Feld JJ, Klein MB, Rahal Y, et al. Timing of elimination of hepatitis C virus in Canada’s provinces. Canadian Liver Journal. November 2022;5(4):493-506.
- Pascual JC, Arias L, Soler J. Pharmacological management of borderline personality disorder and common comorbidities. CNS Drugs. 2023; in press.
- Watson NF, Benca RM, Krystal AD, et al. Alliance for sleep clinical practice guideline on switching or deprescribing hypnotic medications for insomnia. Journal of Clinical Medicine. 2023 Mar 25;12(7):2493.
- Dev R, Fortuno ES 3rd, Amaram-Davila JS, et al. Benefits and risks of off-label olanzapine use for symptom management in cancer patients—a case report. Annals of Palliative Medicine. 2023 May;12(3):600-606.
- Jalil J, Nazarian P, von Walter HF. Polypharmacy in treatment of behavioral issues in dementia—use of atypical antipsychotics. Clinics in Geriatric Medicine. 2022 Nov;38(4):641-652.
- D’Agostino A, Aguglia A, Barbui C, et al. STAR Network Depot Investigators. Off-label long-acting injectable antipsychotics in real-world clinical practice: a cross-sectional analysis of prescriptive patterns from the STAR Network DEPOT study. BMC Psychiatry. 2022 Jun 30;22(1):442.
- Horvitz-Lennon M, Volya R, Hollands S, et al. Factors associated with off-label utilization of second-generation antipsychotics among publicly insured adults. Psychiatric Services. 2021 Sep 1;72(9):1031-1039.
- Nickel NC, Enns JE, Freier A, et al. Methamphetamine Use in Manitoba Research Team. Characterising methamphetamine use to inform health and social policies in Manitoba, Canada: a protocol for a retrospective cohort study using linked administrative data. BMJ Open. 2022 Oct 19;12(10): e062127.