Hepatology

Social support key to successful early HCV treatment


Optimising social support for patients embarking on treatment of hepatitis C (HCV) is a key to good patient outcomes, researchers have found.

Latest research from the Australian Trial of Acute Hepatitis C (ATAHC) study published in PLOS One found that social stability influences treatment uptake and virological outcome, and may continue to do so even as improved antivirals become available for recent HCV infection.

“The findings have implications for support services that accompany HCV treatment programs,” the authors wrote.

“Optimising social support might improve the proportion commencing treatment, virological response and quality of life. A comprehensive individualised assessment of social supports and factors related to social marginalisation may improve treatment outcomes.”

The research team, including Professor Alex Thompson, Professor-Director of Gastroenterology at St Vincent’s Hospital Melbourne, examined the health-related quality of life (HRQOL) and social functioning of patients who underwent treatment of recently acquired HCV infection using pegylated-interferon (PEG-IFN).

While this is effective treatment that results in a sustained cure for a high percentage of patients, it is also characterised by considerable toxicity, including neuropsychiatric side-effects, lethargy, influenza-like symptoms, and cytopenias.

“The potential to adversely affect quality of life, social stability and other co-morbidities creates complexity and limits use of PEG-IFN,” the authors wrote. “While interferon (IFN)-free therapies promise better and simpler treatment, access remains restricted largely due to cost and licensing limitations. Sustained, large scale treatment of recent HCV infection among people who inject drugs (PWID) could have important prevention benefits.”

Professor Thompson said that although the data was from the IFN era, and not transferable to the use of new anti-virals, it had important messages about the importance of optimising social support.

“It makes the important point that stability predicts for good patient outcome,” he told the limbic. “Whilst the boundaries shift with IFN-free treatment, it is important to consider any person considering treatment within their individual psychosocial context.”

Lead author Joseph Doyle said the study found that while there were clearly unpleasant effects from the use of interferon, the good news was that there was little long-term effects on quality of life and good cure rates of 75-80%.

And while he sees the use of interferon fading out in the face of new alternatives, it was important to ensure patients understood the new therapies were nothing like their predecessor.

“The drugs have minimal toxicity and are very effective,” he told the limbic. “There is a mild degree of disbelief that it can’t be that good. But it is very easy to use, very low in toxicity and has very high cure rates even with the trickiest patients.”

He said the study, while related to interferon and not the new drugs, served as a good reminder to treating physicians to consider social issues such as drug addiction and homelessness when treating patients.

“It’s important to think about the whole patient,” he said.

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