Hepatitis C Comorbidities Persist Despite Treatment Advances

Much of the focus on treating hepatitis C virus (HCV) patients in recent years has been on using medications to treat the infection. While advances are promising, most patients today are untreated, particularly those who use illicit drugs and are struggling with comorbidities. These issues will be addressed Friday in Symposium 3, “Neuropsychiatric Complications of HCV Among Drug Users.”

“Hepatitis C has extra-hepatic manifestations that are becoming increasingly well known,” said Jeffrey Samet, MD, MA, MPH, one of the symposium organizers. “This is a hot topic issue that is bringing this infection to the fore. Every addiction medicine physician has patients with these conditions, and whether these issues are being addressed or ignored, they are affecting the patients. One of the organ systems that is markedly affected is the brain, so this symposium will broadly address three topic areas—depressive symptoms, cognitive function, and pain.”

The symposium, which will be presented from 2:30 to 4:30 pm Friday in Orange Ballroom A, Lower Level, features experts in each of those domains, said Dr. Samet, Professor of Medicine and Community Health Services at Boston University Schools of Medicine and Public Health.

Addressing the treatment of depressive symptoms will be Glenn Treisman, MD, PhD, Professor at Johns Hopkins Medicine and Director of its AIDS Psychiatry Service.

“You try to control the depressive symptoms, and for reasons that are not understood, HCV is having some adverse effect on depressive symptoms in drug users,” Dr. Samet noted. “Glenn will talk about how he goes about treating these patients with antidepressant medications.”

Symposium speaker Judith Tsui, MD, MPH, FASAM, Assistant Professor of Medicine at Boston University School of Medicine, will discuss pain, which is perhaps the least understood of these three HCV neurological comorbidities.

“There are interesting mechanisms hypothesized that state that pain is affected by inflammation,” Dr. Samet said. “HCV, as well as HIV, increases the inflammatory burden on the individual. The implications of such a hypothesis for how one might go about treating an individual from an anti-inflammatory or anti-cytokine perspective will be discussed. This area is a bit more exploratory because the data about the direct therapeutic implications is quite limited.”

The third speaker, Igor Grant, MD, Professor and Executive Vice Chair of the Department of Psychiatry at the University of California, San Diego School of Medicine, will discuss the area of cognitive function.

“You can say almost the same thing about cognitive impairment as you can about depressive symptoms,” Dr. Samet said. “The problem is how one addresses cognitive impairment because there are not good medications.”

Jag Khalsa, PhD, MS, Chief of the Medical Consequences Branch of NIDA and the co-developer of the session with Dr. Samet, will explore with the speakers the future of dealing with hepatitis C comorbidities, including why extra-hepatic liver-psychiatric relationships exist.

“The big issue in all three of these areas is that it is anticipated that in the next five years we will see a major increase in anti-HCV therapy being given to patients,” Dr. Samet said. “We are poised to have HCV be cured with effective treatment, but it will be expensive. The question is what becomes of these neuropsychiatric complications? Will they get better? Does the cognitive function improve?

“I have to believe that in the same way our treatments for HIV were a combination of treatments, we will see a comparable dual approach to the neuropsychiatric problems of hepatitis C. That should be very interesting.”