Efficacy and tolerability of DAAs in HCV-monoinfected and HCV/HIV-coinfected patients with psychiatric disorders

Abstract Background few data are available regarding use of direct antiviral agents (DAAs) for chronic hepatitis C in psychiatric patients. The aim of the study is to assess safety and outcome of DAAs in patients with psychiatric comorbidities. Methods this retrospective, observational, single-centre study enrolled patients treated with psychiatric drugs who initiated DAAs between 2015-2018. Patients were classified into two groups: A (on anxiolitycs/antidepressant) and B (on antipsychotics). Week-12 sustained virological response (SVR-12) and adverse events (AEs) were evaluated. Results 144 patients were included (A:101; B:43). Patients were 49.3% males, mean age 60 years (SD±13.5); 31.9% cirrhotic; 125 (86.8%) HCV-monoinfected and 19 (13.2%) HIV/HCV-coinfected. Twenty patients (13.8%) required a change of psychiatric therapy before DAAs-initiation. Overall, SVR-12 was achieved in 88.2% of subjects in intention-to-treat(ITT)-analysis. Lower SVR rates were observed in group B vs A (79% vs 92%, p=0.045) and in those changing psychiatric drugs vs others (30% vs 8%, p=0.015). At least one AE occurred in 60 patients (41.6%), including 10 SAEs, leading to 3 discontinuations. AEs were more frequently reported in group A (p=0.015). Conclusions the study confirms effectiveness and safety of DAA-based treatment also in this special population, even if a careful evaluation of history and drug-drug interactions is warranted.