摘要
Chronic hepatitis C virus(HCV) viral infection is the most common blood-borne viral infection and approximately 2%-3% of the world's population or 170-200 million people are infected. In the United States as many as 3-5 million people may have HCV. Psychiatric and substance use disorders(SUDs) are common co-morbid conditions found in people with HCV and are factors in predisposing people to HCV infection. Also, these co-morbidities are reasons that clinicians exclude people from antiviral therapy in spite of evidence that people with HCV and co-morbid psychiatric and SUD can be safely and effectively treated. Furthermore, the neuropsychiatric side effects of interferon(IFN), until recently the mainstay of antiviral therapy, have necessitated an appreciation and assessment of psychiatric co-morbidities present in people with HCV. The availability of new medications and IFNfree antiviral therapy medication combinations will shorten the duration of treatment and exposure to IFN and thus decrease the risk of neuropsychiatric side effects. This will have the consequence of dramatically altering the clinical landscape of HCV care and will increase the number of eligible treatment candidates as treatment of people with HCV and co-morbid psychiatric and SUDs will become increasingly viable. While economically developed countries will rely on expensive IFN-free antiviral therapy, less developed countries will likely continue to use IFN-based therapies at least until such time as IFNfree antiviral medications become generic. The current manuscript discusses the efficacy and viability of treating HCV in people with psychiatric and SUDs comorbidities, the treatment of the neuropsychiatric side effects of IFN-based therapies and the impact of new medications and new treatment options for HCV that offer the promise of increasing the availability of antiviral therapy in this vulnerable population.
Chronic hepatitis C virus （HCV） viral infection is the mostcommon blood-borne viral infection and approximately2%-3% of the world＇s population or 170-200 millionpeople are infected. In the United States as many as 3-5million people may have HCV. Psychiatric and substanceuse disorders （SUDs） are common co-morbid conditionsfound in people with HCV and are factors in predisposingpeople to HCV infection. Also, these co-morbidities arereasons that clinicians exclude people from antiviraltherapy in spite of evidence that people with HCVand co-morbid psychiatric and SUD can be safely andeffectively treated. Furthermore, the neuropsychiatric sideeffects of interferon （IFN）, until recently the mainstay ofantiviral therapy, have necessitated an appreciation andassessment of psychiatric co-morbidities present in peoplewith HCV. The availability of new medications and IFNfreeantiviral therapy medication combinations will shortenthe duration of treatment and exposure to IFN andthus decrease the risk of neuropsychiatric side effects.This will have the consequence of dramatically alteringthe clinical landscape of HCV care and will increase thenumber of eligible treatment candidates as treatment ofpeople with HCV and co-morbid psychiatric and SUDs willbecome increasingly viable. While economically developedcountries will rely on expensive IFN-free antiviral therapy,less developed countries will likely continue to useIFN-based therapies at least until such time as IFNfreeantiviral medications become generic. The currentmanuscript discusses the efficacy and viability of treatingHCV in people with psychiatric and SUDs comorbidities,the treatment of the neuropsychiatric side effects of IFN-based therapies and the impact of new medications andnew treatment options for HCV that offer the promiseof increasing the availability of antiviral therapy in thisvulnerable population.
