Depression profiles and hepatitis C treatment outcomes among people who inject drugs: The HERO study

Irene Pericot-Valverde¹, Snehal S Lopes², Jessica Obeysekare³, Abigail W Batchelder⁴, Megan Groome⁵, Lynn E Taylor⁶, Kimberly Page⁷, Judith I Tsui⁸, Paula J Lum⁹, Shruti H Mehta¹⁰, Judith Feinberg¹¹, Arthur Y Kim¹², Brianna L Norton¹³, Julia Arnsten¹³, Anna Baker¹⁴, Moonseong Heo², Alain H Litwin¹⁵; HERO Study Group

Affiliations

¹ Department of Psychology, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA; School of Health Research, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA. Electronic address: iperico@clemson.edu.
² Department of Public Health Sciences, Clemson University, Clemson, SC, USA.
³ Department of Psychiatry, Prisma Health, Greer, SC, USA.
⁴ Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
⁵ Prisma Health Addiction Medicine Center, Prisma Health, Greenville, SC, USA.
⁶ Department of Pharmacy Practice and Clinical Research, University of Rhode Island, 7 Greenhouse Road, Kingston, RI, USA.
⁷ Department of Internal Medicine, University of New Mexico Health Sciences Center, University of New Mexico MSC 10 5550, Albuquerque, NM, USA.
⁸ Department of Medicine, University of Washington, 325 9th Ave, Seattle, WA, USA.
⁹ Department of Medicine, University of California San Francisco, 2540 23(rd) Potrero Ave, San Francisco, CA, USA.
¹⁰ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6546, Baltimore, MD, USA.
¹¹ Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, 930 Chestnut Ridge Road, Morgantown, WV, USA; Department of Medicine, Section of Infectious Diseases, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, USA.
¹² Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
¹³ Albert Einstein College of Medicine, Bronx, NY, USA; Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.
¹⁴ Department of Psychology, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA.
¹⁵ Department of Psychology, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA; School of Health Research, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA; Prisma Health Addiction Medicine Center, Prisma Health, Greenville, SC, USA; Department of Medicine, University of South Carolina School of Medicine, 876 W Faris Rd, Greenville, SC, USA; Department of Medicine, Prisma Health, Greenville, SC, USA.

PMID: 41124945
DOI: 10.1016/j.jpsychores.2025.112417

Free article

Randomized Controlled Trial

Depression profiles and hepatitis C treatment outcomes among people who inject drugs: The HERO study

Irene Pericot-Valverde et al. J Psychosom Res. 2025 Dec.

Free article

. 2025 Dec:199:112417.

doi: 10.1016/j.jpsychores.2025.112417. Epub 2025 Oct 17.

Authors

Affiliations

¹ Department of Psychology, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA; School of Health Research, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA. Electronic address: iperico@clemson.edu.
² Department of Public Health Sciences, Clemson University, Clemson, SC, USA.
³ Department of Psychiatry, Prisma Health, Greer, SC, USA.
⁴ Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
⁵ Prisma Health Addiction Medicine Center, Prisma Health, Greenville, SC, USA.
⁶ Department of Pharmacy Practice and Clinical Research, University of Rhode Island, 7 Greenhouse Road, Kingston, RI, USA.
⁷ Department of Internal Medicine, University of New Mexico Health Sciences Center, University of New Mexico MSC 10 5550, Albuquerque, NM, USA.
⁸ Department of Medicine, University of Washington, 325 9th Ave, Seattle, WA, USA.
⁹ Department of Medicine, University of California San Francisco, 2540 23(rd) Potrero Ave, San Francisco, CA, USA.
¹⁰ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6546, Baltimore, MD, USA.
¹¹ Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, 930 Chestnut Ridge Road, Morgantown, WV, USA; Department of Medicine, Section of Infectious Diseases, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, USA.
¹² Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
¹³ Albert Einstein College of Medicine, Bronx, NY, USA; Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.
¹⁴ Department of Psychology, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA.
¹⁵ Department of Psychology, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA; School of Health Research, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA; Prisma Health Addiction Medicine Center, Prisma Health, Greenville, SC, USA; Department of Medicine, University of South Carolina School of Medicine, 876 W Faris Rd, Greenville, SC, USA; Department of Medicine, Prisma Health, Greenville, SC, USA.

PMID: 41124945
DOI: 10.1016/j.jpsychores.2025.112417

Abstract

Background: Evidence suggests that depression profiles may be differentially associated with healthcare engagement. Relying solely on total scores may limit our understanding of depression among people who inject drugs (PWID) living with hepatitis C virus (HCV). This study aimed to (1) identify latent baseline depression symptom profiles and their correlates in HCV-infected PWID; (2) examine changes in depressive symptoms from baseline to follow-up by symptom profile and HCV cure status; and (3) examine the association between baseline depression symptom profiles and HCV treatment outcomes (adherence, completion, and sustained virologic response (SVR)).

Methods: A secondary data analysis of the HERO Study was conducted with 498 PWID undergoing direct-acting antiviral (DAA) treatment. Latent class analysis classified participants into distinct baseline depression symptom profiles using the Patient Health Questionnaire-9 (PHQ-9). Changes in PHQ-9 scores and adherence were estimated using linear mixed-effects models, and logistic regression tested the impact of baseline depression symptom profile on treatment completion and SVR.

Results: Three depression profiles were identified: Class 1 (n = 63/498) showed no symptoms. Class 2 (n = 148/498) was characterized by sleep difficulties, fatigue, and appetite changes. Class 3 (n = 287/498) endorsed all PHQ-9 items except suicidal thoughts and showed higher rates of urine toxicology tests positive for cocaine. Depression scores post-HCV treatment varied by SVR status, with those who did not achieve SVR showing persistent depression. Adherence, completion, and SVR did not differ across classes.

Discussion: Severe depression among HCV-infected PWID underscores the critical importance of assessing, monitoring, and treating these symptoms during HCV treatment, particularly for those not achieving HCV cure.

Clinical trials number: NCT02824640.

Keywords: DAA; Depression profiles; HCV; PWID; SVR.

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Conflict of interest statement

Declaration of competing interest None.

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Depression profiles and hepatitis C treatment outcomes among people who inject drugs: The HERO study

Affiliations

Depression profiles and hepatitis C treatment outcomes among people who inject drugs: The HERO study

Authors

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms

Substances

Associated data

LinkOut - more resources

Full Text Sources

Medical