Hepatitis C treatment of patients with bipolar disorder: a case series.
BACKGROUND
Hepatitis C virus (HCV) chronic infection affects 10% to 15% of patients with bipolar disorder. Patients with HCV infection and comorbid psychiatric illness pose a tremendous clinical and therapeutic challenge. The cases presented in this report illustrate several critical issues facing clinicians who manage patients with comorbid HCV infection and bipolar disorder.


METHODS
Five cases are described in which patients with DSM-IV bipolar disorder were treated with interferon-alpha-based therapies and ribavirin to induce viral clearance of HCV. In all cases, the patients were treated using an integrated model of care, and the treatment decision was a consensus between the treating hepatologists and psychiatrists.


RESULTS
In the first case, the patient had no significant neuropsychiatric adverse effects and had viral clearance. In 2 other cases, viral clearance of HCV was achieved through the delicate management of affective symptoms induced by interferon-alpha and ribavirin. Interferon-alpha and ribavirin treatment was halted due to mania and suicidal ideation in the 2 remaining cases.


CONCLUSIONS
These cases suggest that patients with hepatitis C and bipolar disorder should be evaluated for HCV antiviral treatments, as these patients can receive and tolerate these treatments if assessed meticulously, observed carefully, and followed extensively during interferon-alpha and ribavirin treatment. This case series will hopefully spark a dialogue about when HCV antiviral treatment should be withheld or delayed in these difficult cases.
Rifai
Muhamad Aly
MA
Office of the Clinical Director, National Institute of Mental Health, National Institutes of Health, Bethesda, Md, USA. AlyRifai@mail.nih.gov