title: Hepatitis C infection is associated with depressive symptoms in HIV-infected adults with alcohol problems.
abstract: OBJECTIVE
  Depression is common in persons with HIV infection and with alcohol problems, and it has important prognostic implications. Neurocognitive dysfunction has been reported with chronic hepatitis C virus (HCV) infection. We hypothesized that HCV infection is associated with more depressive symptoms in HIV-infected persons with a history of alcohol problems.
  
  
  METHODS
  We performed a cross-sectional analysis of baseline data from a prospective cohort study of 391 HIV-infected subjects with a history of alcohol problems, of whom 59% were HCV antibody (Ab) positive and 49% were HCV RNA-positive. We assessed depressive symptoms (Center for Epidemiologic Studies Depression [CES-D]) and past month alcohol consumption. In the primary analysis, we evaluated whether there were more depressive symptoms in HCV Ab-positive and RNA-positive subjects in unadjusted analyses and adjusting for alcohol consumption, gender, age, race, CD4 count, homelessness, drug dependence, and medical comorbidity.
  
  
  RESULTS
  Mean CES-D scores were higher in subjects who were HCV Ab-positive compared with those who were HCV Ab-negative (24.3 vs 19.0; p < 0.001). In adjusted analyses, the difference in CES-D scores between HCV Ab-positive and Ab-negative subjects persisted (24.0 vs 19.0; p < 0.001). Unadjusted mean CES-D scores were also significantly higher in HCV RNA-positive subjects compared with those who were RNA-negative, and the difference remained significant (24.6 vs 19.3; p < 0.001) in adjusted analyses.
  
  
  CONCLUSIONS
  HCV/HIV coinfected persons with a history of alcohol problems have more depressive symptoms than those without HCV, and this association is unexplained by a variety of population characteristics. These data suggest that HCV may have a direct effect on neuropsychiatric function.
authors.affiliation: Division of General Medicine and Primary Care and Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Libman
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
authors.forename: David
authors.initials: D
authors.lastname: Nunes
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Richardson
authors.forename: John
authors.initials: J
authors.lastname: Vidaver
authors.forename: Julie K
authors.initials: JK
authors.lastname: Alperen
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D000367:Age Factors; D000437:Alcoholism / Q000150:complications / Q000523:psychology*; D015153:Blotting, Western; D018791:CD4 Lymphocyte Count; D016009:Chi-Square Distribution; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000523:psychology*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000523:psychology*; D006703:Ill-Housed Persons; D006801:Humans; D016014:Linear Models; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D012737:Sex Factors