Abstract
Background
Chronic hepatitis C (HCV) infected patients with coexisting mental health and/or substance abuse issues face significant barriers to treatment and are often deferred. This paper sought to highlight critical pre-treatment strategies and provide tangible resources for HCV clinicians to facilitate preparation and successful treatment of these patients.
Methods
Guided by the clinical experience of our liver center, a large, tertiary academic medical center, and informed by the extant literature, we summarize pre-treatment strategies and specific resources and recommendations for HCV providers.
Results
Four key pre-treatment strategies include: 1) screening for mental health/substance abuse issues using brief, reliable and validated instruments; 2) locating and establishing collaborative care with mental health and substance abuse specialists; 3) using a motivational interviewing communication style; and 4) addressing adherence-related issues.
Conclusions
HCV clinicians are in a unique position to prepare patients with coexisting mental health and/or substance abuse issues for antiviral therapy.
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Abbreviations
- MH/SA:
-
Mental health/substance abuse
- HCV:
-
Chronic hepatitis C virus
- SVR:
-
Sustained virological response
References
U.S. Food and Drug Administration. FDA approves Victrelis for Hepatitis C [FDA News Release web site]. May 13, 2011. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm255390.htm. Accessed 7 June 2011.
U.S. Food and Drug Administration. FDA approves Incivek for hepatitis C [FDA News Release web site]. May 23, 2011. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm256299.htm. Accessed 20 March 2012.
Volk ML. Antiviral therapy for hepatitis C: why are so few patients being treated? J Antimicrob Chemother. 2010;65:1327–1329.
Volk ML, Tocco R, Saini S, et al. Public health impact of antiviral therapy for hepatitis C in the United States. Hepatology. 2009;50:1750–1755.
Davis GL, Alter MJ, El-Serag H, et al. Aging of hepatitis C virus (HCV)-infected persons in the United States: a multiple cohort model of HCV prevalence and disease progression. Gastroenterology. 2010;138:513–521.
Kramer JR, Kanwal F, Richardson P, et al. Importance of patient, provider, and facility predictors of hepatitis C virus treatment in veterans: a national study. Am J Gastroenterol. 2011;106:483–491.
Kanwal F, Hoang T, Spiegel BM, et al. Predictors of treatment in patients with chronic hepatitis C infection—role of patient versus nonpatient factors. Hepatology. 2007;46:1741–1749.
Stepanova M, Kanwal F, El-Serag HB, et al. Insurance status and treatment candidacy of hepatitis C patients: analysis of population-based data from the United States. Hepatology. 2011;53:737–745.
Evon DM, Verma A, Dougherty KA, et al. High deferral rates and poorer treatment outcomes for HCV patients with psychiatric and substance use comorbidities. Dig Dis Sci. 2007;52:3251–3258.
Muir AJ, Provenzale D. A descriptive evaluation of eligibility for therapy among veterans with chronic hepatitis C virus infection. J Clin Gastroenterol. 2002;34:268–271.
Falck-Ytter Y, Kale H, Mullen KD, et al. Surprisingly small effect of antiviral treatment in patients with hepatitis C. Ann Intern Med. 2002;136:288–292.
Butt AA, Wagener M, Shakil AO, et al. Reasons for non-treatment of hepatitis C in veterans in care. J Viral Hepat. 2005;12:81–85.
Schaefer M, Schmidt F, Folwaczny C, et al. Adherence and mental side effects during hepatitis C treatment with interferon alfa and ribavirin in psychiatric risk groups. Hepatology. 2003;37:443–451.
Schaefer M, Heinz A, Backmund M. Treatment of chronic hepatitis C in patients with drug dependence: time to change the rules? Addiction. 2004;99:1167–1175.
Schaefer M, Schwaiger M, Garkisch AS, et al. Prevention of interferon-alpha associated depression in psychiatric risk patients with chronic hepatitis C. J Hepatol. 2005;42:793–798.
Schaefer M, Hinzpeter A, Mohmand A, et al. Hepatitis C treatment in “difficult-to-treat” psychiatric patients with pegylated interferon-alpha and ribavirin: response and psychiatric side effects. Hepatology. 2007;46:991–998.
Grebely J, Genoway K, Khara M, et al. Treatment uptake and outcomes among current and former injection drug users receiving directly observed therapy within a multidisciplinary group model for the treatment of hepatitis C virus infection. Int J Drug Policy. 2007;18:437–443.
Knott A, Dieperink E, Willenbring ML, et al. Integrated psychiatric/medical care in a chronic hepatitis C clinic: effect on antiviral treatment evaluation and outcomes. Am J Gastroenterol. 2006;101:2254–2262.
Sylvestre DL, Loftis JM, Hauser P, et al. Co-occurring Hepatitis C, substance use, and psychiatric illness: treatment issues and developing integrated models of care. J Urban Health. 2004;81:719–734.
Sylvestre DL. Treating hepatitis C virus infection in active substance users. Clin Infect Dis. 2005;40:S321–S324.
Sylvestre DL, Clements BJ. Adherence to hepatitis C treatment in recovering heroin users maintained on methadone. Eur J Gastroenterol Hepatol. 2007;19:741–747.
Matthews G, Kronborg IJ, Dore GJ. Treatment for hepatitis C virus infection among current injection drug users in Australia. Clin Infect Dis. 2005;40:S325–S329.
Freedman K, Nathanson J. Interferon-based hepatitis C treatment in patients with pre-existing severe mental illness and substance use disorders. Expert Rev Anti Infect Ther. 2009;7:363–376.
Zanini B, Covolo L, Donato F, et al. Effectiveness and tolerability of combination treatment of chronic hepatitis C in illicit drug users: meta-analysis of prospective studies. Clin Ther. 2010;32:2139–2159.
Bruggmann P, Falcato L, Dober S, et al. Active intravenous drug use during chronic hepatitis C therapy does not reduce sustained virological response rates in adherent patients. J Viral Hepat. 2008;15:747–752.
Bruggmann P, Dampz M, Gerlach T, et al. Treatment outcome in relation to alcohol consumption during hepatitis C therapy: an analysis of the Swiss Hepatitis C Cohort study. Drug Alcohol Depend. 2010;110:167–171.
Evon DM, Esserman DA, Rao T, et al. Patient missed doses and treatment non-persistence during PEG/Ribavirin therapy for chronic hepatitis C: implications for triple therapy and beyond. Hepatology. 2011;54:869A.
Leutscher PD, Lagging M, Buhl MR, et al. Evaluation of depression as a risk factor for treatment failure in chronic hepatitis C. Hepatology. 2010;52:430–435.
Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measurement. 1977;1:385–401.
Evon DM, Ramcharran D, Belle SH, et al. Prospective analysis of depression during peginterferon and ribavirin therapy of chronic hepatitis C: results of the VIRAHEP-C study. American Journal of Gastroenterology. 2009;104:2949–2958.
Beck AT, Steer RA, Ball R, et al. Comparison of beck depression inventories -IA and -II in psychiatric outpatients. J Pers Assess. 1996;67:588–597.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–613.
Hirschfeld RM, Williams JB, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry. 2000;157:1873–1875.
Nassir GS, Miller CJ, Berv DA, et al. Sensitivity and specificity of a new bipolar spectrum diagnostic scale. J Affect Disord. 2005;84:273–277.
Saunders JB, Aasland OG, Babor TF, et al. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88:791–804.
Yudko E, Lozhkina O, Fouts A. A comprehensive review of the psychometric properties of the Drug Abuse Screening Test. J Subst Abuse Treat. 2007;32:189–198.
Sylvestre D. Hepatitis C treatment in drug users: perception versus evidence. Eur J Gastroenterol Hepatol. 2006;18:129–130.
Rollnick S, Miller W, Butler C. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: The Guilford Press; 2007.
Emmons KM, Rollnick S. Motivational interviewing in health care settings. Opportunities and limitations. Am J Prev Med. 2001;20:68–74.
Miller WR, Rollnick S. Motivational interviewing: preparing people for change. New York: Guilford Press; 2002.
Martins RK, McNeil DW. Review of motivational interviewing in promoting health behaviors. Clin Psychol Rev. 2009;29:283–293.
Knight KM, McGowan L, Dickens C, et al. A systematic review of motivational interviewing in physical health care settings. Br J Health Psychol. 2006;11:319–332.
Searight HR. Efficient counseling techniques for the primary care physician. Prim Care. 2007;34:551–570.
Lev-Ran S, Nitzan U. Motivational interviewing in health care. Harefuah. 2011;150:749.
Callahan EJ, Flynn NM, Kuenneth CA, et al. Strategies to reduce HIV risk behavior in HIV primary care clinics: brief provider messages and specialist intervention. AIDS Behav. 2007;11:S48–S57.
Rubak S, Sandbaek A, Lauritzen T, et al. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005;55:305–312.
Miller WR. Enhancing motivation for change in substance abuse treatment. Treatment improvement protocol (TIP) series 35. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. DHHD Publication No. (SMA) 99-3354. Rockville, MD; 1999.
Rifai MA, Moles JK, Lehman LP, et al. Hepatitis C screening and treatment outcomes in patients with substance use/dependence disorders. Psychosomatics. 2006;47:112–121.
Dieperink E, Ho SB, Heit S, et al. Significant reductions in drinking following brief alcohol treatment provided in a hepatitis C clinic. Psychosomatics. 2010;51:149–156.
Berg CJ, Michelson SE, Safren SA. Behavioral aspects of HIV care: adherence, depression, substance use, and HIV-transmission behaviors. Infect Dis Clin North Am. 2007;21:181–200.
Golin C, Isasi F, Bontempi JB, et al. Secret pills: HIV-positive patients’ experiences taking antiretroviral therapy in North Carolina. AIDS Educ Prev. 2002;14:318–329.
Haynes RB, Ackloo E, Sahota N, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008;CD000011.
Hendershot CS, Stoner SA, Pantalone DW, et al. Alcohol use and antiretroviral adherence: review and meta-analysis. J Acquir Immune Defic Syndr. 2009;52:180–202.
McHutchison JG, Manns M, Patel K, et al. Adherence to combination therapy enhances sustained response in genotype-1-infected patients with chronic hepatitis C. Gastroenterology. 2002;123:1061–1069.
Martin-Santos R, Diez-Quevedo C, Castellvi P, et al. De novo depression and anxiety disorders and influence on adherence during peginterferon-alpha-2a and ribavirin treatment in patients with hepatitis C. Aliment Pharmacol Ther. 2008;27:257–265.
Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133:21–30.
Weiden PJ. The adherence interview: Better information, better alliance. Psychiatric Annals Online, 2011; 41 (online only). Available at: http://www.psychiatricannalsonline.com/view.asp?rID=84071. Accessed 15 June 2011.
Hill S, Kavookjian J. Motivational interviewing as a behavioral intervention to increase HAART adherence in patients who are HIV-positive: a systematic review of the literature. AIDS Care. (Epub ahead of print). doi:10.1080/09540121.2011.630354.
Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47:826–834.
Martin LR, Williams SL, Haskard KB, et al. The challenge of patient adherence. Ther Clin Risk Manag. 2005;1:189–199.
Tanioka D, Iwasaki Y, Araki Y, et al. Factors associated with adherence to combination therapy of interferon and ribavirin for patients with chronic hepatitis C: importance of patient’s motivation and physician’s treatment experience. Liver Int. 2009;29:721–729.
Simoni JM, Amico KR, Pearson CR, et al. Strategies for promoting adherence to antiretroviral therapy: a review of the literature. Curr Infect Dis Rep. 2008;10:515–521.
Golin CE, Liu H, Hays RD, et al. A prospective study of predictors of adherence to combination antiretroviral medication. J Gen Intern Med. 2002;17:756–765.
Vezali E, Aghemo A, Colombo M. Interferon in the treatment of chronic hepatitis C: a drug caught between past and future. Expert Opin Biol Ther. 2011;11:301–313.
Kanwal F, Hoang T, Kramer JR, et al. Increasing prevalence of HCC and cirrhosis in patients with chronic hepatitis C virus infection. Gastroenterology. 2011;140:1182–1188.
Acknowledgements
Donna Evon receives research grant support from Roche, and served on an advisory board for Vertex Pharmaceuticals in the past 12 months. Michael Fried receives research grants from Genentech, Vertex, Tibotec, Janssen, Gilead, Abbott, Bristol-Myers Squibb, Anadys. Dr. Fried also serves as an ad hoc consultant to Genentech, Vertex, Merck, Tibotec, Janssen, Bristol-Myers Squibb, Novartis and Gilead. Sid Barritt is on the speaker's bureau for Salix Pharmaceuticals and receives research grant support from Tibotec. This work was supported, in part, by a UNC Clinical and Translational Science Award (UL1RR025747; Bonner); the National Institutes of Health Awards (1KL2-RR025746-03; Barritt; and K23DK089004-02; Evon) and a mentoring grant (K24 DK066144-01; Fried).
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Dr. Bonner has nothing to disclose.
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Bonner, J.E., Barritt, A.S., Fried, M.W. et al. Tangible Resources for Preparing Patients for Antiviral Therapy for Chronic Hepatitis C. Dig Dis Sci 57, 1439–1444 (2012). https://doi.org/10.1007/s10620-012-2142-3
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DOI: https://doi.org/10.1007/s10620-012-2142-3