Servei de Psiquiatria i Psicologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdicas August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Barcelona, Spain.
Braz J Psychiatry. 2020 Jan-Feb;42(1):72-76. doi: 10.1590/1516-4446-2018-0336.
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.
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.
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]).
The findings of this study highlight the importance of screening for new depression among patients receiving new DAAs, and identify potential associated risk factors.
抑郁症与丙型肝炎及其治疗中促炎细胞因子（即干扰素）有关。新型直接作用抗病毒药物（DAA）具有最小的不良反应和高效力，对非结构病毒蛋白具有直接抑制作用。我们研究了在接受新型 DAA 治疗的慢性丙型肝炎患者的真实前瞻性队列中，抑郁的发生率和相关因素。
该样本是从一个由 91 名丙型肝炎患者组成的队列中招募的，包括男性和女性，纤维化程度较高，无 HIV 合并感染，在 6 个月的时间内连续招募用于 DAA 治疗；选择基线时情绪稳定的患者（n=54）。所有患者均通过患者健康问卷（PHQ-9-DSM-IV）的抑郁模块进行评估，共 3 个时间点：基线、4 周和治疗结束时。
在 DAA 治疗期间，重度抑郁症和任何抑郁障碍的累积发生率（95%CI）分别为 13%（6.4-24.4）和 46.3%（33.7-59.4）。在有或没有肝硬化或利巴韦林治疗的患者之间未观察到差异（p>0.05）。DAA 治疗期间新发重度抑郁症的危险因素包括家族抑郁（相对风险 9.1 [1.62-51.1]）、物质使用障碍（11.0 [1.7-73.5]）和基线 PHQ-9 评分（2.1 [1.1-3.1]）。
本研究结果强调了在接受新型 DAA 治疗的患者中筛查新发抑郁症的重要性，并确定了潜在的相关危险因素。
