Snapshots, by Alan Franciscus, Editor-in-Chief

Article: Depression rather than liver impairment reduces quality of life in patients with hepatitis C—LD Silva, et al
  Source: Rev Bras Psiquiatr. 2015 Jan-Mar;37(1):21-30. doi: 10.1590/1516-4446-2014-1446
Results and Conclusion: In the current study there were 124 patients (72 females; 52 males; mean age 53 yo).  The patients were given various clinical and psychiatric evaluations.  No patients were receiving HCV treatment.  Various in-person interviews were given to determine socio-economic information, health-related quality of life, income, smoking, alcohol and drug use. 

The study results found that 30.6% had major depressive disorder, which is consistent with other studies. The degree of major depressive disorder and other psychiatric disorders found in people with hepatitis C is associated with health-related quality of life rather than tied to the degree of liver fibrosis.  The authors noted that more attention needs to be devoted to “the implementation of integrated medical, psychiatric, and [that] psychological care may be helpful.”
The Bottom Line: Up to 70% of people with chronic hepatitis C have depressive disorders—this is a seven-fold higher rate than the general population.
Editorial Comment: Does HCV cause depression?  Many experts believe that the hepatitis C virus causes depression, but the exact mechanism hasn’t been completely understood.  There have been some studies that have shown that the hepatitis C virus passes the blood-brain barrier and there have been viral particles found in brain tissue.  Another possible reason for depressive disorders could potentially be the results of the immune system cells fighting off the virus in brain tissue.   

Regardless of what causes depression in people with hepatitis C, it is clear that curing hepatitis C also can increase the quality of life leading to a wide variety of improvements in health including mental health. It’s time that we recognize that we should treat everyone with hepatitis C regardless of the degree of liver damage—hepatitis C is NOT just a liver disease.
Article: Changes in characteristics of hepatitis C patients seen in a liver center in the United States during the last decade—N Talaat et al.
  Source: Journal of Viral Hepatitis Volume 22,Issue 5, pages 481–488, May 2015
Results and Conclusion: This was a retrospective study of the records of patients seen in liver clinics 1998-1999 (Era-1) compared to the records of patients seen 2011-2012 (Era-2)
The current study sought to describe the characteristics of people with HCV who were newly referred to liver clinics in Era-1 (538 patients). The records from Era-1 patients were compared to those of patients who were seen in Era-2 (810 patients).  Advanced liver disease was defined as cirrhosis, decompensated cirrhosis, or liver cancer.  

The patients in Era-2 were older (median age 56 vs 45 years), more likely to be Black (17.2% vs 11.6%) and had a longer interval between diagnosis and referral (median 4 years vs 2 years).  Genotype 1 was similar in both Era’s, but genotype 1a was 39.9% vs 53.8% in Era-2.  

Even though there was a higher percentage of treatment-experienced patients in the Era 2 patient group, the comparison showed that more than three quarters of the patients had never been treated.    
Era-2 patients were more likely to have advanced disease at referral (61.6% vs 51.5%)—with an   eightfold higher prevalence of HCC or liver cancer (21.6% vs 2.6%).
The Bottom Line:  The changes in the Era-2 patients points to important trends in the hepatitis C population.  These changes occurred over a relatively short period of time:   
Editorial Comment:  This study speaks volumes.  In this short period of time there has been a major advance in the rate of liver disease progression—most notably the increase in liver cancer is frightening.

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