Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 28, 2015; 7(15): 1921-1935
Published online Jul 28, 2015. doi: 10.4254/wjh.v7.i15.1921
Psychiatric and substance use disorders co-morbidities and hepatitis C: Diagnostic and treatment implications
Peter Hauser, Shira Kern
Peter Hauser, VISN 22 Network Office, Long Beach, CA 90822, United States
Peter Hauser, Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA 92697, United States
Peter Hauser, Department of Psychiatry, University of California San Diego, San Diego, CA 92093, United States
Peter Hauser, Shira Kern, VA Long Beach Healthcare System, Long Beach, CA 90822, United States
Author contributions: Hauser P and Kern S are the sole contributors to this manuscript.
Conflict-of-interest statement: The authors claim no conflict of interest at this time.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Peter Hauser, MD, VISN 22 Network Offices, 300 Oceangate Avenue, Suite 700, Long Beach, CA 90822, United States.
Telephone: +1-562-8268000-2629 Fax: +1-562-8262221
Received: January 25, 2015
Peer-review started: January 26, 2015
First decision: March 6, 2015
Revised: June 21, 2015
Accepted: June 30, 2015
Article in press: July 2, 2015
Published online: July 28, 2015

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 IFN-free 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 IFN-free 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.

Keywords: Hepatitis C, Psychiatric disorders, Substance use disorders, Antiviral treatment

Core tip: Hepatitis C viral (HCV) is among the most common blood-borne viral infections in the world. Although disease management strategies are often complicated by the high rate of psychiatric and substance use disorders (SUDs) within this population, studies now indicate that neuropsychiatric side effects can be effectively managed during antiviral therapy and that individuals with pre-existing psychiatric and SUDs can be treated successfully and achieve sustained virologic response. Furthermore, the development of new medication options for the treatment of HCV has provided additional opportunities for treatment of people with HCV who have - or are at risk for - psychiatric illness.