An estimated fifteen to twenty five thousand people in New Hampshire have Hepatitis C. The virus is the most common blood borne infection in the United States and the leading cause of liver transplants. Among people with mental illness the prevalence of the virus is ten times that of the general population. Yet many of these patients have traditionally been denied the best treatment option available, a drug called Interferon.
The side effects of Interferon are thought to bring on certain mood disorders, which has caused doctors to shy away from prescribing the treatment to people with a history of mental illness. But a new article published this month in the journal Psychosomatics casts doubt on that approach.
New Hampshire Public Radio's Kerry Grens has more.
Leaving Hepatitis untreated can lead to liver disease, cirrhosis, liver cancer, and liver failure.
Interferon drugs have been used for fifteen years to treat the virus.
They are effective in about fifty percent of cases—but they are the best treatment option available for a disease that is making an increasing number of people in this state ill.
But Doctor Lisa Mistler at New Hampshire Hospital says an entire group of people has been denied access to Interferon drugs.
Mistler: The recommendations clinically up until about 2000 or 2002 were actually that you not ever offer this treatment to anyone who’s ever had a history of a mental illness.
Today, the clinical recommendations are to screen patients for mental illness.
But there is a fear hanging over the medical world that the potential side effects could be so severe in patients with mental illness that Interferon treatment should be discouraged.
Doctor Mistler says that fear is not based on reliable data.
Mistler and her colleagues at Dartmouth reviewed all the available evidence on Interferon side effects in people with mental illness and found it to be pretty sparse.
Mistler: The studies have eliminated having folks with any history of mental illness whatsoever. So all the studies that had been done with Interferon treatment of Hepatitis C had been done on people who are presumed to be psychologically quote unquote stable. So we don’t have a lot of evidence.
For people who don’t have a history of mental illness, side effects of Interferon treatment do include depression.
But Mistler says there are data showing the depression can be treated successfully and patients can continue with Interferon.
She says the same approach can be applied to patients with a history of mental illness.
And she’s begun treating Hepatitis C patients who have severe mental illness with Interferon as part of a study out of Dartmouth.
Mistler: We’ve treated a small number of folks here in the hospital actually to start. We’ve had some successes. We’ve had some folks who completely eradicated the virus, which is a very very good thing to see. And these are people who probably never would have gotten this treatment outside the hospital or as outpatients because of their history of mental illness.
She says it takes a few extra steps, like close monitoring of mood and ensuring good social supports.
Her goal is to see patients with mental illness who live in the community to have the same access to Interferon as anyone else wanting to treat Hepatitis C.
SOQ
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