Therapie der chronischen Hepatitis C bei Patienten mit psychischen Erkrankungen

Zusammenfassung

70 - 90 % der Patienten mit einer intravenösen Drogenabhängigkeit sind chronisch mit dem Hepatitis-C-Virus (HCV) infiziert und haben eine Indikation zur antiviralen Therapie mit pegyliertem Interferon-α plus Ribavirin. Eine bei dieser Patientengruppe jedoch häufig vorhandene psychiatrische Komorbidität stellt bei den zahlreichen möglichen psychischen Nebenwirkungen des Interferon- α eine zumindest relative Kontraindikation dar, aufgrund derer die Patienten immer noch häufig von einer Therapie ausgeschlossen werden. Die in diesem Artikel zusammengefasste aktuelle Studienlage zeigt jedoch, dass auch bei Patienten mit einer Drogenabhängigkeit und psychischen Störungen während der HCV-Therapie gleiche Ansprechraten und gute Haltequoten erreicht werden können, wenn die Patienten interdisziplinär betreut werden. Nur schwere und aktuell exazerbierte psychiatrische Krankheitsbilder sollten daher Kontraindikationen gegen eine Therapie mit Interferon- α darstellen.

Abstract

70 - 90 % of intravenous drug users are chronically infected with the hepatitis C virus and would need antiviral treatment with pegylated interferon- α and ribavirin. However, because interferon- α can induce severe psychiatric side effects, especially the presence of psychiatric comorbidities often tends to result in an exclusion from the otherwise helpful antiviral treatment. Recent trials about hepatitis C treatment for intravenous drug users demonstrate that response rates and adherence do not significantly differ between patients with or without drug addiction, even in case of psychiatric disorders, if patients are treated in an interdisciplinary setting. Thus, only severe and unstable psychiatric conditions should still be regarded as contraindication against antiviral treatment with interferon- α.

Schlüsselwörter

Hepatitis C - Interferon-α - psychische Störungen - Drogenabhängigkeit - Nebenwirkungen

Key words

Hepatitis C - Interferon-α - psychiatric disorders - drug addiction - side-effects

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