Depressive symptoms are no longer a barrier to HCV treatment initiation in the HIV–HCV co-infected population in Canada

IF 1.3 4区 医学 Q4 INFECTIOUS DISEASES Antiviral Therapy Pub Date : 2022-02-01 DOI:10.1177/13596535211067610
Gayatri Marathe, E. Moodie, M. Brouillette, J. Cox, C. Delaunay, C. Cooper, M. Hull, J. Gill, S. Walmsley, N. Pick, M. Klein
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Abstract

Background Psychiatric illness was a major barrier for HCV treatment during the Interferon (IFN) treatment era due to neuropsychiatric side effects. While direct acting antivirals (DAA) are better tolerated, patient-level barriers persist. We aimed to assess the effect of depressive symptoms on time to HCV treatment initiation among HIV–HCV co-infected persons during the IFN (2003–2011) and second-generation DAA (2013–2020) eras. Methods We used data from the Canadian Co-infection Cohort, a multicentre prospective cohort, and its associated sub-study on Food Security (FS). We predicted Center for Epidemiologic Studies Depression Scale-10 (CES-D-10) classes for depressive symptoms indicative of a depression risk using a random forest classifier and corrected for misclassification using predictive value-based record-level correction. We used marginal structural Cox proportional hazards models with inverse weighting for competing risks (death) to assess the effect of depressive symptoms on treatment initiation among HCV RNA-positive participants. Results We included 590 and 1127 participants in the IFN and DAA eras. The treatment initiation rate increased from 9 (95% confidence interval (CI): 7–10) to 21 (95% CI: 19–22) per 100 person-years from the IFN to DAA era. Treatment initiation was lower among those with depressive symptoms compared to those without in the IFN era (hazard ratio: 0.81 (95% CI: 0.69–0.95)) and was higher in the DAA era (1.19 (95% CI: 1.10–1.27)). Conclusion Depressive symptoms no longer appear to be a barrier to HCV treatment initiation in the co-infected population in the DAA era. The higher rate of treatment initiation in individuals with depressive symptoms suggests those previously unable to tolerate IFN are now accessing treatment.
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在加拿大HIV-HCV合并感染人群中,抑郁症状不再是开始HCV治疗的障碍
背景:在干扰素(IFN)治疗时代,由于神经精神方面的副作用,精神疾病是HCV治疗的主要障碍。虽然直接作用抗病毒药物(DAA)耐受性较好,但患者层面的障碍仍然存在。本研究旨在评估IFN(2003-2011)和第二代DAA(2013-2020)时期HIV-HCV合并感染者中抑郁症状对HCV治疗开始时间的影响。方法:我们使用来自加拿大合并感染队列(一个多中心前瞻性队列)及其食品安全相关子研究(FS)的数据。我们使用随机森林分类器预测流行病学研究中心抑郁量表-10 (CES-D-10)抑郁症状等级,并使用基于预测值的记录水平校正来纠正错误分类。我们使用具有竞争风险(死亡)逆加权的边际结构Cox比例风险模型来评估HCV rna阳性参与者中抑郁症状对治疗开始的影响。结果IFN期和DAA期分别纳入590名和1127名受试者。从IFN到DAA时代,治疗起始率从每100人年9例(95%可信区间(CI): 7-10)增加到21例(95% CI: 19-22)。在IFN时代,有抑郁症状的患者的治疗起始率低于无抑郁症状的患者(风险比:0.81 (95% CI: 0.69-0.95)),而在DAA时代,治疗起始率更高(风险比:1.19 (95% CI: 1.10-1.27))。结论在DAA时代,抑郁症状不再是HCV合并感染人群开始治疗的障碍。有抑郁症状的个体开始接受治疗的比率较高,这表明那些以前不能耐受干扰素的人现在正在接受治疗。
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来源期刊
Antiviral Therapy
Antiviral Therapy 医学-病毒学
CiteScore
2.60
自引率
8.30%
发文量
35
审稿时长
4-8 weeks
期刊介绍: Antiviral Therapy (an official publication of the International Society of Antiviral Research) is an international, peer-reviewed journal devoted to publishing articles on the clinical development and use of antiviral agents and vaccines, and the treatment of all viral diseases. Antiviral Therapy is one of the leading journals in virology and infectious diseases. The journal is comprehensive, and publishes articles concerning all clinical aspects of antiviral therapy. It features editorials, original research papers, specially commissioned review articles, letters and book reviews. The journal is aimed at physicians and specialists interested in clinical and basic research.
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