Yvonne Chasser1, Arthur Y Kim2, Oliver Freudenreich3. 1. MGH-McLean Adult Psychiatry Residency Training Program, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: ychasser@partners.org. 2. Division of Infectious Diseases, Department of Child Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA. 3. Schizophrenia Clinical and Research Program, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Abstract
BACKGROUND: Hepatitis C virus (HCV) is a widespread and costly cause of morbidity and mortality globally and in the United States. The treatment of HCV has been revolutionized with the recent development of direct-acting antiviral medications. These new treatments are substantially better tolerated and more efficacious than previously used interferon-based therapies. Despite these innovations, sustained virologic response has remained low, hovering at approximately 9% of all infected persons. The reasons for this failure include lack of screening, low rates of linkage to care, cost of direct-acting antivirals, and barriers in access to care for patients. Psychiatrists work with patients at a disproportionately high risk for HCV infection yet many do not currently assume an active role in the HCV epidemic. OBJECTIVE: The purpose of this clinical review is to familiarize psychiatrists with currently available hepatitis C treatments and discuss the remaining treatment challenges, including the high cost of treatment. METHODS: The authors used information from the Centers for Disease Control and Food and Drug Administration on the most current estimates of HCV epidemiology, risk factors, and approved interferon-free treatments. PUBMED was searched for examples of HCV treatment in community psychiatry settings. CONCLUSIONS: The mental health community is well-positioned to take on a more active role in HCV treatment and engage patients׳ trust in the treatment process. However, many barriers still exist. We encourage psychiatrists to assume a collaborative role in caring for psychiatric patients infected with HCV.
BACKGROUND:Hepatitis C virus (HCV) is a widespread and costly cause of morbidity and mortality globally and in the United States. The treatment of HCV has been revolutionized with the recent development of direct-acting antiviral medications. These new treatments are substantially better tolerated and more efficacious than previously used interferon-based therapies. Despite these innovations, sustained virologic response has remained low, hovering at approximately 9% of all infected persons. The reasons for this failure include lack of screening, low rates of linkage to care, cost of direct-acting antivirals, and barriers in access to care for patients. Psychiatrists work with patients at a disproportionately high risk for HCV infection yet many do not currently assume an active role in the HCV epidemic. OBJECTIVE: The purpose of this clinical review is to familiarize psychiatrists with currently available hepatitis C treatments and discuss the remaining treatment challenges, including the high cost of treatment. METHODS: The authors used information from the Centers for Disease Control and Food and Drug Administration on the most current estimates of HCV epidemiology, risk factors, and approved interferon-free treatments. PUBMED was searched for examples of HCV treatment in community psychiatry settings. CONCLUSIONS: The mental health community is well-positioned to take on a more active role in HCV treatment and engage patients׳ trust in the treatment process. However, many barriers still exist. We encourage psychiatrists to assume a collaborative role in caring for psychiatricpatients infected with HCV.