title: Depression and fatigue in chronic hepatitis C patients with and without HIV co-infection.
abstract: BACKGROUND
  Depression and fatigue are common in chronic hepatitis C (CHC).
  
  
  OBJECTIVE
  We report clinical predictors of these conditions in patients seen in a university clinic.
  
  
  METHODS
  A total of 167 CHC patients completed the Patient Health Questionnaire-9 (PHQ-9) and Fatigue Severity Scale (FSS). Major depressive disorder (MDD) suggested by PHQ-9 was confirmed by clinical interview. FSS scores ≥41 were considered clinically significant fatigue. Logistic and multiple regression models were employed for analysis.
  
  
  RESULTS
  Thirty-three percent of patients had MDD and 52% had clinically significant fatigue. Sixty-one percent were HIV-infected, among whom both MDD and clinically significant fatigue were significantly less prevalent (OR = 0.47 and 0.46, respectively). MDD was least common in patients without a history of IV drug use (OR = 0.28), and highest in methadone users (OR = 3.57). Compared with methadone users, patients with no history of IV drug use and former IV drug users had less severe fatigue (coefficients = -31.0, -34.0, respectively). Lack of a history of hepatitis treatment was also associated with less severe fatigue (coefficient= -7.6).
  
  
  CONCLUSIONS
  Our study confirms high prevalence of fatigue and depression in CHC. HIV-positivity was associated with lower rates of MDD and clinically significant fatigue, arguably due to support systems for people living with HIV. Higher rates of depression in methadone users might be due to intrinsically higher rates of psychopathology in this group. Being on hepatitis treatment was associated with higher rates of fatigue, probably due to the adverse effects of interferon. Our findings emphasize the importance of routine screening and evaluation of depression and fatigue in CHC populations.
authors.affiliation: Department of Psychiatry, NY-Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Tavakkoli
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Ferrando
authors.forename: Judith
authors.initials: J
authors.lastname: Rabkin
authors.forename: Kristen
authors.initials: K
authors.lastname: Marks
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Talal
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D060085:Coinfection; D003865:Major Depressive Disorder / Q000150:complications / Q000523:psychology*; D005221:Fatigue / Q000150:complications / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000523:psychology*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000523:psychology; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000523:psychology; D011795:Surveys and Questionnaires