Depressive and Anxious Symptoms in Hepatitis C Virus Infected Patients Receiving DAA-Based Therapy

Abstract

Hepatitis C virus (HCV) represents the most important etiologic factor for advanced fibrosis/cirrhosis and hepatocellular carcinoma associated with a psychological dimension. Our study aims to assess, on a sample comprising of 90 HCV-infected subjects (96.67% F3-F4 METAVIR), the relationship between Direct-Acting Antiviral (DAA) therapies and the psychological effects of the liver disease, focused on the anxious and depressive symptoms. The comprehensive evaluation was done before starting the DAA treatment (BSL), after 12 weeks (End of Treatment-EOT), respectively after another 12 weeks (Sustained Viral Response-SVR). Presumable depressive and/or anxious symptoms were evaluated by Hospital Anxiety and Depression Scale (HADS). The reported depressive symptoms decreased from 21.11% (BSL) to 1.11% (SVR) (p < 0.00001), while the anxious ones dropped from 43.34% (BSL) to 4.44% (SVR) (p < 0.00001), without a clear evolutionary pattern. We identified no statistically significant interaction between comorbidities (anemia, CKD, obesity) over HADS scores evolution (p > 0.05), while the DAAs side-effects (fatigue, headache, pruritus) significantly influenced the anxious and depressive symptoms (p < 0.05). During and after the DAA-based therapy, patients with HCV infection presented a significantly reduced rate of the associated depressive and anxious relevant symptoms.

Keywords: Direct Acting Antivirals; Hepatitis C virus; anxiety; depression; fibrosis; sustained virological response.

Figure 1

Patients flow diagram for the whole process of DAAs intervention. The study arm consisted of 90 subjects from BSL to SVR.

Figure 2

Graphic description of the anxious and depressive symptoms evolution during the study period (gender distribution). HADS scores showed similar patterns of the identified mental health disorders according to the patient’s gender. The dynamic measures of HADS scores showed a significant positive evolution of the psychological status for the subjects included in the study. (A) Evolution of HADS-A scores at the three moments of assessment in female subjects; (B) Evolution of HADS-D scores at the three moments of assessment in female subjects; (C) Evolution of HADS-A scores at the three moments of assessment in male subjects; (D) Evolution of HADS-D scores at the three moments of assessment in male subjects.