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. 2023 Oct 5;10(11):ofad498.
doi: 10.1093/ofid/ofad498. eCollection 2023 Nov.

Reduction in Depressive Symptoms in People who Inject Drugs who Are Cured of Hepatitis C Virus Infection: The HERO Study

Irene Pericot-Valverde  1 , Snehal S Lopes  2 , Shadi Nahvi  3 , James F Thrasher  4 , Alison Karasz  5 , Lynn E Taylor  6 , Shruti H Mehta  7 , Paula J Lum  8 , Judith I Tsui  9 , Kimberly Page  10 , Judith Feinberg  11 , Arthur Y Kim  12 , Brianna L Norton  3 , Julia H Arnsten  3 , Sergio Fernandez-Artamendi  13 , Moonseong Heo  2 , Alain Litwin  1   14   15 ; HERO Research Group
Collaborators, Affiliations

Reduction in Depressive Symptoms in People who Inject Drugs who Are Cured of Hepatitis C Virus Infection: The HERO Study

Irene Pericot-Valverde et al. Open Forum Infect Dis. .

Abstract

Background: Depressive symptoms are prevalent among people who inject drugs (PWID) and people with hepatitis C virus (HCV). We examined changes in depressive symptoms among HCV-infected PWID following direct-acting antiviral treatments to evaluate whether these changes differed by history of depressive symptoms, substance use, or HCV treatment outcome.

Methods: We conducted a secondary analysis of the HERO Study (NCT02824640), a pragmatic randomized clinical trial among PWID, to test the effectiveness of HCV care models. Depressive symptoms (primary outcome) were measured using the Patient Health Questionnaire (PHQ-9) at baseline, end of treatment (EOT), and at follow-up 12 and 24 weeks after EOT. Sustained virologic response (SVR) was defined as undetectable HCV RNA at ≥12 weeks following EOT. Baseline drug use was defined as having a positive urine screening test for amphetamine, methamphetamine, benzodiazepine, cocaine, cannabis, opiate, or oxycodone.

Results: The sample (n = 498) was 72.3% male, 64.2% White, and on average 43.9 years old. In patients who achieved SVR (F(3432) = 4.58; P = .004) and those with drug use at baseline (F(3478) = 5.11; P < .01), PHQ-9 scores significantly declined over time, with scores lower at EOT and both follow-ups as compared with baseline. Mean PHQ-9 scores at EOT and follow-ups were significantly lower than at baseline, except for those with no depression or mild depression at baseline.

Conclusions: This study showed that HCV treatment in PWID is associated with sustained declines in depression up to 24 weeks post-treatment among those who achieve SVR and that drug use does not interfere with improvement in depressive symptoms.

Keywords: DAA medication; HCV; PWID; depression.

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Conflict of interest statement

Potential conflicts of interest. J.F. has received research grant support from Gilead Sciences. A.Y.K. has served on advisory boards for Biomarin. A.F.L. has received research grant support from Gilead and Merck. The Task Force for Global Health receives funds for the general support of the Coalition for Global Hepatitis Elimination from Abbott, Gilead, AbbVie, Merck, Siemens, Roche, Pharco, Zydus-Cadila, governmental agencies, and philanthropic organizations. A.H.L. has served on advisory boards for Gilead Sciences and Merck Pharmaceuticals and received research funding from Gilead Sciences. S.H.M. has received speaker fees from Gilead Sciences. All other authors declare no competing interests.

Figures

Figure 1.
Figure 1.
Estimates of PHQ-9 scores at each research visit by SVR status for overall participants (A, N = 498; SVR = 459 and no SVR = 39) and for participants with PHQ-9 scores ≥10 (B, N = 228; SVR = 223 and no SVR = 5). Error bars represent standard error. Abbreviations: BL, baseline; EOT, end of treatment; FU, follow-up; PHQ-9, Patient Health Questionnaire; SVR, sustained virologic response.
Figure 2.
Figure 2.
Estimates of PHQ-9 scores at each research visit for the overall sample (A, N = 498; severe = 49, moderately severe = 68, moderate = 122, minimal to mild = 259), participants who achieved SVR (B, N = 459; severe = 44, moderately severe = 62, moderate = 119, minimal to mild = 234), and participants who did not achieve SVR (C, N = 39; severe = 5, moderately severe = 6, moderate = 3, minimal to mild = 25). Error bars represent standard error. Abbreviations: BL, baseline; EOT, end of treatment; FU, follow-up; PHQ-9, Patient Health Questionnaire; SVR, sustained virologic response.
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