Psychiatric disorders and hepatitis C treated with direct-acting antivirals in a French reference center

HCV can cause psychiatric disorders. It is crucial to re-evaluate them with direct-acting antiviral treatment (DDAs), since the interferon-based treatments of the past were capable of causing identical psychiatric adverse effects. A system of multidisciplinary team (MDT) meetings was implemented in France in December 2014 in regional reference centers with the aim of controlling the prescription and administration of these new treatments, along with optimizing how the patients undergoing these treatments are followed up. Our study sought to compare the characteristics and type of medical care received for chronic hepatitis C in patients with (PSY+ group) and without (PSY- group) psychiatric disorders using data from MDT meetings in the Alsace area of France collected from 2015 to 2019. All included patients were mono-infected and treated with DAAs in successive rounds between 2015 and 2019, as per recommendations from the French Hepatology Society. We compared the two groups (PSY+ and PSY-) based on 21 variables regarding the characteristics and medical care of hepatitis C. Psychiatric disorders were observed in 15% of patients. On multivariate analysis, a positive correlation was found between them and drug use (OR: 2.35; 95%CI: 1.40-3.98; p=0.001), excessive alcohol consumption (OR: 1.92; 95%CI: 0.98-3.69; p=0.05), smoking (OR: 1.81; 95%CI: 1.09-2.98; p=0.02), and incidence of drug interactions (OR: 3.94; 95%CI: 2.15-7.17; p <0.001). The only negative correlation found was with pangenotypic DAA administration (OR: 0.55; 95%CI: 0.32-0.92; p=0.02). SVR 12 was 98.05% in the PSY+ group, not significantly different from that of the PSY- group. All in all, the psychiatric disorders observed in patients suffering from chronic hepatitis C are primarily associated with using psycho-active substances, with no impact on SVR 12 rates. Lay summary The psychiatric disorders observed in patients suffering from chronic hepatitis C treated with direct-acting antivirals are primarily associated with drug use, excessive alcohol consumption and tobacco consumption. They increase the incidence of drug interactions. They have no impact on virological healing. Highlights: 15% of patients with HCV monoinfection treated with direct-acting antivirals were suffering from psychiatric disorders. Psychiatric disorders were associated with drug use. They were also associated with other psycho-active substances (alcohol and tobacco). They increased the incidence of drug interactions. They have no impact on sustained virological response.