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Time to Rethink Antiviral Treatment for Hepatitis C in Patients with Coexisting Mental Health/Substance Abuse Issues

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Abstract

Background

A new era has dawned in the treatment of chronic hepatitis C (HCV) virus with the use of direct-acting antiviral medications augmenting combination therapy. Unfortunately, the significant impact of improvements may not be realized if antiviral treatment is not expanded to include a larger proportion of patients, many of whom have coexisting mental health and/or substance abuse issues and have been historically deferred from treatment.

Methods

We reviewed the extent literature on HCV treatment for individuals with co-occurring mental health and/or substance abuse issues.

Results

A number of empirically-based arguments exist in favor of treating HCV-infected individuals with mental health and/or substance abuse issues within the context of multidisciplinary team approaches. Integrated, collaborative, or hybrid models of care are just a few examples of multidisciplinary approaches that can combine the care of HCV treating providers with mental health and/or addictions providers to safely and effectively treat these patients. Collectively, these arguments and the empirical evidence that supports them, provides a strong rationale for why expanding antiviral therapy to these patients is critical and timely.

Conclusions

A decade of evidence suggests that HCV-infected individuals with mental health and/or substance abuse issues can safely and effectively undergo antiviral treatment when delivered through multidisciplinary care settings. Multidisciplinary approaches that combine HCV treating providers with mental health, addictions, and other support systems can facilitate preparation and successful treatment of these patients on antiviral therapy.

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

HCV:

Chronic hepatitis C virus

MH/SA:

Mental health/substance abuse

SVR:

Sustained virological response

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Acknowledgments

Donna Evon receives research grant support from Roche, and served on an advisory board for Vertex Pharmaceuticals in the past 12 months. Michael Fried has had research grant funding and has served as ad hoc consultant for Roche. Dr. Fried also serves as ad hoc consultant to Vertex, Merck, Tibotec, Pharmasset, GlaxoSmithkline, 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).

Conflict of interest

Dr. Bonner has nothing to disclose.

Disclosures

Dr. Fried receives research grants from Genentech, Vertex, Tibotec, Janssen, Gilead, Abbott, BristolMyers Squibb, Anadys. He serves as an ad hoc consultant to Genentech, Vertex, Merck, Tibotec, Janssen, BristolMyers Squibb, Novartis, Gilead.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, 8010 Burnett-Womack Bldg, CB#7584, Chapel Hill, NC, 27599, USA

    Jason E. Bonner, A. Sidney Barritt IV, Michael W. Fried & Donna M. Evon

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  1. Jason E. Bonner
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  2. A. Sidney Barritt IV
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  3. Michael W. Fried
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  4. Donna M. Evon
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Correspondence to Donna M. Evon.

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Bonner, J.E., Barritt, A.S., Fried, M.W. et al. Time to Rethink Antiviral Treatment for Hepatitis C in Patients with Coexisting Mental Health/Substance Abuse Issues. Dig Dis Sci 57, 1469–1474 (2012). https://doi.org/10.1007/s10620-012-2141-4

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  • DOI: https://doi.org/10.1007/s10620-012-2141-4

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