Use of Psychiatric Drugs in Patients With Hepatitis C Review and Recommendations

ease that is often asymptomatic for decades. Three hundred million people worldwide and 3.2 million in the United States are estimated to be infected with hepatitis C virus (HCV), which is a single-stranded ribonucleic acid virus. It is a leading indication for liver transplantation worldwide and is associated with high rates of cirrhosis and hepatocellular carcinoma. Chronic, active hepatitis C is also associated with high rates of substance use and mood, anxiety, and personality disorders. Diagnosis is first established by screening for anti-HCV antibodies and confirmed with a viral load and genotyping. There are six genotypes and many subgroups of hepatitis C. Genotypes 1a and 1b are the most common in the United States, and genotypes 2 and 3 are responsible for most cases elsewhere in the world. Patients with severe mental illness are at high risk of infection, especially in the presence of comorbid substance use.Although intravenous drug use is the highest risk factor, use of crack cocaine also substantially increases the risk of hepatitis C transmission. Additionally, sex-trade involvement and impulsivity found in substance abusers promotes high-risk behaviors resulting in increased transmission of viral hepatitis, HIV, and other sexually transmitted diseases (Table 1). There is evidence of an unrecognized epidemic of hepatitis C in the population with severe mental illness. Because patients with chronic hepatitis C often have normal liver function tests (LFTs) and aminotransferase levels, those with any history of intravenous drug use, crack cocaine use, or high-risk sexual behavior should be offered screening. Infected patients need a complete medical evaluation to rule out hepatic insufficiency and hepatocellular carcinoma. Those with hepatitis C should also be educated regarding the risk factors for transmission and treatment After participating in this activity, the psychiatrist should be better able to: