Credit: Pexels / Inzmam Khan

Patients with severe mental disorders who do not use drugs are not at a higher risk of developing hepatitis c virus (HCV) or hepatitis B virus (HBV) than the general population, according to new research.¹

A team, led by Tábatha Fernández, Psychiatry and Psychology Department, Hospital Clínic de Barcelona, evaluated the real prevalence of hepatitis B and C virus in individuals with severe mental disorders in the area of influence of Hospital Clínic in Barcelona.The team also analyzed who achieved HCV microelimination in the subpopulation.

The Risk

Patients with severe mental disorders are generally part of a high-risk population for bloodborne virus infections. However, identifying risk factors can be important as it has become easier in recent years to treat diseases like HBV and HCV.

“With the development of oral direct antiviral agents (DAAs) in the last years, HCV has become an easily treatable and curable infection, dramatically changing the current HCV clinical scenario by a deep reduction in fibrosis progression and liver-related morbimortality once viral cure is achieved,” the authors wrote. “Patients with severe mental disorders, defined as a chronic mental disorder of at least two years duration that causes a high degree of personal and social dysfunction, have been classically considered as a particularly high-risk population in which HCV assessment should be performed.”

One common issue is that access to HCV treatment historically has been limited or outright avoided by patients with severe mental disorders due to treatment with interferon-based regimens, known to generate adverse neuropsychiatric effects, including depression and suicidal ideation.

Study

In the study, the investigators screened a pair of anti-HCV and HBsAg cohorts, 1 of which included hospitalized patients with severe mental disorders and 1 of which included outpatients at a mental health center between July 1, 2021 and May 31, 2022.The first cohort was populated systematically (n = 404), while the second cohort was done so voluntarily (n = 305).

If a participant had a substance abuse disorder as a main mental disorder, and were receiving care Drug Dependency Care and Monitoring Centres or Harm Reduction Centres they were followed up excluded from the study

The investigators collected risk factors and socio-demographic variables and used Hepatology, calculation of FIB-4 and prescription of direct-acting agents (DAA) in HCV or follow-up in HBV to activate the telematic review of positive cases.

The mean age of cohort A was 43 years.

Of the patients in the first cohort, 0.7% (n = 3) had HBV, all of which had a history of drug use. In addition, 3% (n = 12) were anti-HCV positive, 8 of which had a history of drug use.

Among the patients who were positive for HCV, only 2 patients were viremic. Both of these patients received DAA treatment and achieved SVR.

The remaining 6 patients had already been cured with DAA therapy.

In the second cohort, there were no cases of HCV or HBV identified.

“HCV/HBV prevalence among SMD population with no history of drug use does not seem to be different from the general population,” the authors wrote. “These data may be of interest for defining health policies.”