title: Bipolar patients can safely and successfully receive interferon-based hepatitis C antiviral treatment.
abstract: OBJECTIVE
  Patients with bipolar disease are often not considered for hepatitis C virus (HCV) antiviral treatment and are excluded from clinical trials because of the risk of interferon-induced exacerbation of their underlying mood disorder. As this risk has not been well quantified in bipolar patients, we evaluated the safety and efficacy of HCV treatment in this population.
  
  
  METHODS
  A retrospective analysis of HCV patients evaluated at The Ottawa Hospital between January 2000 and February 2008 (n=910) was carried out. Information on demographics, psychiatric history and treatment, baseline liver biopsy and blood work, treatment initiation, adherence, and therapeutic outcomes was collected. This was compared between bipolar patients (B), those with a history of depression (D), and those with no mental health disorders (N).
  
  
  RESULTS
  Of 38 bipolar patients (4.2%), 16 (42.1%) initiated HCV treatment, a rate similar to that in patients with a history of depression (41.4%) and in those without psychiatric illness (32.6%). On-treatment psychiatric complications were comparable between the bipolar and depression groups (B=68.8%, D=54.8%; P=0.29) and were higher than in those without psychiatric illness (N=37.1%; P=0.01). Manic episodes were rare. [B=2 (12.5%), D=1 (0.9%), N=1 (0.7%)]. Interferon dose reduction or discontinuation rates for psychiatric complications (B=12.5%, D=7.9%, N=7.4%; P=NS), completion rates (B=50%, D=69%, N=58%), and sustained virologic response rates (genotype 1: B=33%, D=45%, N=49%) were similar between the groups.
  
  
  CONCLUSIONS
  Stable bipolar patients have similar rates of on-treatment psychiatric complications as patients with a history of depression. With pharmacologic intervention and close clinical monitoring, well-selected bipolar patients can successfully complete treatment and achieve outcomes comparable to those in nonbipolar patients.
authors.affiliation: Department of Medicine, The Ottawa Hospital, Division of Infectious Diseases, Viral Hepatitis Program, University of Ottawa, Ottawa, Canada. ekelly@toh.on.ca
authors.forename: Erin M
authors.initials: EM
authors.lastname: Kelly
authors.forename: Kimberly
authors.initials: K
authors.lastname: Corace
authors.forename: Joel
authors.initials: J
authors.lastname: Emery
authors.forename: Curtis L
authors.initials: CL
authors.lastname: Cooper
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications* / Q000523:psychology; D003863:Depression / Q000139:chemically induced / Q000150:complications / Q000523:psychology; D004341:Drug Evaluation; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D007372:Interferons