Dollarhide Adrian W, Loh Catherine, Leckband Susan G, Endow-Eyer Rene, Robinson Shannon, Meyer Jonathan M
VA San Diego Healthcare System, San Diego, CA 92161, USA.
J Clin Gastroenterol. 2007 Mar;41(3):322-8. doi: 10.1097/01.mcg.0000225629.22286.96.
The aim of this study was to evaluate the impact of common psychiatric disorders on treatment completion of antiviral therapy prescribed to a series of hepatitis C virus (HCV) positive US veterans.
Clinical experience suggests that preexisting psychiatric conditions may adversely affect the ability to tolerate combination antiviral therapy in patients with HCV infection.
We performed a retrospective chart review of 130 HCV positive veterans treated with combination antiviral therapy [interferon (IFN)/ribavirin] at VA San Diego from 2000 to 2004. We examined baseline psychiatric and substance use diagnoses, as well as demographic and comorbid medical disease variables for all patients started on treatment.
Thirteen percent of patients in our cohort required treatment discontinuation for neuropsychiatric adverse effects. There was no association between treatment completion and any specific psychiatric diagnosis, baseline use of antidepressants, history of substance abuse/dependence, or combined psychiatric and substance use diagnoses for patient groups receiving either standard or pegylated IFN plus ribavirin therapies. Psychiatric and substance use disorders were not associated with dropout due to neuropsychiatric adverse effects. Baseline comorbid medical disorders also did not predict treatment completion. However, higher body weight did predict likelihood of treatment completion, especially for those > or =100 kg compared with thinner subjects (odds ratio=2.90; P=0.037).
In this cohort of veterans, prior psychiatric or substance use history did not predict completion of recommended IFN/ribavirin treatment. These findings suggest that a larger pool of veterans with psychiatric or substance use disorders may be considered candidates for antiviral therapy when provided with multidisciplinary support.
本研究旨在评估常见精神疾病对一系列丙型肝炎病毒（HCV）阳性美国退伍军人所开抗病毒治疗完成情况的影响。
临床经验表明，先前存在的精神疾病可能会对HCV感染患者耐受联合抗病毒治疗的能力产生不利影响。
我们对2000年至2004年在圣地亚哥退伍军人事务部接受联合抗病毒治疗[干扰素（IFN）/利巴韦林]的130名HCV阳性退伍军人进行了回顾性病历审查。我们检查了所有开始治疗的患者的基线精神和物质使用诊断，以及人口统计学和合并的内科疾病变量。
我们队列中的13%患者因神经精神不良反应需要停药。对于接受标准或聚乙二醇化IFN加利巴韦林治疗的患者组，治疗完成与任何特定的精神诊断、基线抗抑郁药使用、药物滥用/依赖史或精神和物质使用合并诊断之间均无关联。精神和物质使用障碍与因神经精神不良反应而退出治疗无关。基线合并的内科疾病也不能预测治疗完成情况。然而，较高的体重确实可以预测治疗完成的可能性，尤其是体重≥100 kg的患者与较瘦的患者相比（优势比=2.90；P=0.037）。
在这个退伍军人队列中，先前的精神或物质使用史不能预测推荐的IFN/利巴韦林治疗的完成情况。这些发现表明，当获得多学科支持时，更多患有精神或物质使用障碍的退伍军人可能被视为抗病毒治疗的候选人。
