A longitudinal study evaluating the effects of interferon-alpha therapy on cognitive and psychiatric function in adults with chronic hepatitis C

Abstract

Objective: To prospectively evaluate for changes in objective cognitive performance (attention, memory, and executive function) and psychiatric symptom severity (depression, anxiety, fatigue, and pain) in patients before, during and after interferon-alpha based therapy (IFN) for chronic hepatitis C virus infection (HCV).

Methods: 33 HCV+ adults were evaluated two months before IFN initiation (baseline), three months into IFN, and six months following IFN termination (IFN+ Group). 31 HCV+ adults who did not undergo IFN therapy were evaluated at baseline and six months later (IFN- Group). At each evaluation, participants completed the Neuropsychological Assessment Battery (NAB) Attention, Memory and Executive Functions Modules, the Beck Depression Inventory, Second Edition (BDI), Generalized Anxiety Disorder Inventory (GADI), Fatigue Severity Scale (FSS), and Brief Pain Inventory (BPI).

Results: Compared with the IFN- Group, the IFN+ Group experienced significantly (p<0.050) increased symptoms of depression, anxiety, fatigue and pain during IFN therapy relative to baseline. In the IFN+ Group, psychiatric symptoms generally returned to baseline levels following IFN termination. Sustained viral response was associated with significantly lower depression and fatigue. No significant changes in cognitive performance were observed.

Conclusions: During IFN, patients with HCV evidence significantly increased psychiatric symptoms, including symptoms of depression, anxiety, fatigue and pain. These psychiatric symptoms are generally short-term and remit following IFN termination, with increased benefit if viral clearance is achieved. However, IFN is not associated with significant declines in objective cognitive performance during or following IFN.

Keywords: Anxiety; Cognition; Depression; Fatigue; Hepatitis C; Interferon; Pain.

Fig. 1

Psychiatric symptom rating scale scores before, during and after interferon alpha-based antiviral therapy (IFN) for hepatitis C virus (HCV) infection (IFN+ Group, n = 33). Significant (p < 0.05) changes across visits were observed on the Beck Depression Inventory, Second Edition (BDI) Total, BDI Somatic Factor, BDI Cognitive Affective Factor, Generalized Anxiety Disorder Inventory (GADI), Fatigue Severity Scale (FSS), and Brief Pain Inventory-Pain Interference (BPI-PI); specifically, psychiatric symptoms increased at Visit 2 during IFN and then returned to near baseline levels at Visit 3 following IFN termination. Inset box illustrates that for individuals undergoing IFN for HCV (IFN+ Group), there were significant effects of sustained viral response (SVR) on fatigue (FSS), overall depression (BDI Total), and somatic depression (BDI Somatic Factor) scores. Participants who achieved an SVR (n= 19) reported less fatigue (p= 0.017), less overall depression (p = 0.038), and fewer somatic depressive symptoms (p = 0.028), as compared with those who did not achieve an SVR (n= 6).