Psychiatric management of HIV/HCV-coinfected patients beginning treatment for hepatitis C virus infection: survey of provider practices.
OBJECTIVE
To determine expert clinical practice in the management of psychiatric status of HIV/hepatitis C virus (HCV)-coinfected patients initiating pegylated interferon/ribavirin for the treatment of hepatitis C.


METHODS
Two hundred thirty-six expert providers were identified and invited by email to complete an online anonymous survey.


RESULTS
Ninety-two providers (39%) completed the survey, 24 (26%) of whom are psychiatrists. More than one third of providers indicate that they use or offer the option of antidepressant use prophylactically in HIV-positive patients with no past or current depression beginning HCV treatment, and more than three quarters do so in patients with a history of depression but no current symptoms of depression. The most experienced nonpsychiatrist providers were more likely to use antidepressants prior to the start of treatment in HIV-coinfected patients as compared to in HCV monoinfected patients. There is consensus among providers to leave psychiatric medication unchanged in patients currently treated for unipolar depression.


CONCLUSIONS
Many expert providers prescribe antidepressants to HIV/HCV-coinfected patients initiating Hepatitis C treatment in the absence of symptoms of depression, despite the lack of data supporting this approach in this population. Research is needed to provide an evidence base to guide the optimal psychiatric management of HIV/HCV-coinfected patients beginning hepatitis C treatment.
Weiss
Jeffrey J
JJ
Department of Psychiatry, Mount Sinai School of Medicine, Box 1228, New York, NY 10029, USA. jeffrey.weiss@msnyuhealth.org
Morgello
Susan
S
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015897:Comorbidity; D003866:Depressive Disorder / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology; D019317:Evidence-Based Medicine; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D006302:Health Services Research; D006306:Health Surveys; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000009:adverse effects* / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011994:Recombinant Proteins; D012254:Ribavirin / Q000009:adverse effects* / Q000627:therapeutic use; D014481:United States
D000928:Antidepressive Agents; D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a