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Hepatitis C and Cognitive Impairment

Interferon (IFN)-á plus ribavirin is an effective treatment for hepatitis C virus (HCV) infection, but is associated with a high rate of depression. Depression has been linked to a worse outcome in multiple medical disorders including viral illnesses. We examined whether increased symptoms of depression during IFNá/ribavirin therapy were associated with a reduced treatment response as assessed by clearance of HCV. Depressive symptoms were evaluated in 102 HCV-infected patients at baseline and after 4, 8, 12, and 24 weeks of pegylated IFN-á-2b plus ribavirin therapy using the Zung self-rating depression scale (SDS). Viral clearance was determined at 24 weeks by polymerase chain reaction (PCR). Only 34% of subjects (10 out of 29) with a 20-point or greater increase in SDS Index score were HCV PCR negative at 24 weeks, compared to 59% (24 out of 41) of patients with a 10-19 point increase in SDS Index and 69% (22 out of 32) of patients with a less than 10 point increase (÷2=7.6, df=2, p<0.05). In addition, a 20-point or greater increase in SDS Index score during IFN-á/ribavirin therapy significantly predicted failure to clear virus when considered alone (crude odds ratio 3.2; 95% confidence interval 1.3-8.0; p<0:01) or when controlling for other factors that affected IFN-á treatment response (adjusted OR, 3.6; 95% CI, 1.3-9.5; p=0.01). These preliminary findings suggest that individuals who experience significant increases in depressive symptoms during IFN-á/ribavirin therapy may be less likely to clear virus, highlighting the importance of identifying and treating depressive symptoms in this patient population. Cancer Chemo, CFS, and Hepatitis C: WHAT THEY HAVE IN COMMON Posted Feb 20 09 7:22pm What do people who've had chemotherapy and treatment for Hepatitis C have in common with people with CFS and Fibromyalgia? Many of them experience brain fog, memory loss and fatigue both during treatment and afterward. People with CFS have immune systems that are out of whack. Interferonalpha (IFN-alpha) is a cytokine that’s used in the treatment of hepatitis C. Interferon activates the immune system and produces an illness that resembles CFS (e.g., fatigue, cognitive complaints, pain, sleep disturbance, and depression) and researchers are looking at this phenomenon to help understand what goes on in the CFS immune system. But at the same time just like with cancer chemotherapy there is in some a lasting “CFS like” experience. In some people their interferon treatment actually kick starts a CFS like illness as illustrated in this quote from a piece “From Skepticism to Science.” "The other study...that just knocked my socks off was hepatitis C. This was a study done by a hepatitis specialist who was treating hepatitis C with interferon," a protein that is part of the body's anti-viral response...."Seventy percent developed marked fatigue, and 30 percent developed chronic fatigue syndrome. So it was the interferon treatment that caused the CFS, not the actual virus circulating in their system....The CFS is the immune response from an infection." This finding is consistent with the idea that the symptoms of CFS could be precipitated by an immune system in overdrive. Hepatitis C treatment is well known for being neurotoxic (it’s toxic to the brain). And although in many people neurotoxic symptoms resolve soon after treatment ends some patients develop neurotoxic side effects that persist for months or years after treatment discontinuation. Some post-cancer patients also experience this sort of fatigue (central fatigue) that’s now referred to as “chemo brain. The immune and stress response (HPA axis) are affected and both play a role in the mysterious problems that cancer and infection patients face, just like those with CFS. Researchers have seen that "chemo brain" seems be related to a reversible shrinking of brain structures induced by chemotherapy. Too many people post-chemo or neurotoxic treatments have struggled to get recognition and validation they need and deserve.