ABSTRACT
Background: Chronic Hepatitis C [CHC] is highly prevalent in Pakistan. Current standard treatment is Interferon alpha/ Peginterferon with oral ribavirin. Interferon therapy is associated with development and worsening of depressive symptoms in CHC patients and to determine the frequency of depressive and anxiety symptoms among patients on treatment with interferon/ Pegasus
Methods: This cross sectional study was conducted at OPD of Liaquat University Hospital Hyderabad during a period of 4 months [from July2013 to October2013]. A sample of 120 patients aged 18-60 years, either currently receiving interferon/ Pegasus treatment or had received that treatment during last 12 months was taken. Known cases of anxiety, depression and those suffering from other debilitating co morbid conditions like carcinoma and non-consenting were excluded. Ethical approval was taken from LUH ethical review committee. A Proforma was used to gather the data. The data collected were analyzed using SPSS version 20.0. Mean [+/-SD] were computed for quantitative variables. Categorical variables [such as gender and outcome variables i.e. anxiety and depressive symptoms] were measured in frequencies and percentages. Stratification was done with regard to age group and gender to see the impact of these on the outcome followed by application of chi-square test with P-value <0.05 taken significant
Results: Total 120 patients were included in the study and 119 completed the questionnaire. Male patients were 55.5%. Mean age of patients was 32.59 +/- 8.56 years [Range: 16-56 years]. Primary outcome i-e; frequency of depression and anxiety in patients on interferon were 77.3% and 70.6% respectively. [n=92] had depression. Frequency of depression of almost similar in both genders [77.3% in males and 77.4% in females; p value= 0.584], while anxiety was more in females than males [75% vs 68.2%; p value= 0.273]. Both psychiatric symptoms increased with increasing age from 16-26 years to 47-56 years of age [p values = 0.432 and 0.736 respectively]. Vast majority [86.6%] were treated with interferon while only 13.4% received the PEGylated interferon therapy. Patients treated with PEGylated interferon had less frequency of depression than those treated with interferon [62.5% vs 79.6%; p value= 0.131]
Conclusion: Depression and anxiety were found to be common in CHC patients who had been or are being treated with antiviral treatment leading to increased risk of morbidity and mortality. Screening for risk of depression, proper education and timely treatment through anti-depressant followed by close monitoring is mandatory to achieve success in antiviral treatment
ABSTRACT
Sharing of blades and shaving kits, especially unsterilized ones are known risk factors for the transmission of Hepatitis C. The objective of this study was to determine the prevalence of Hepatitis C antibodies reactivity among the patients admitted due to any medical condition and who have been visiting roadside barbers. This was a descriptive study conducted from July 2007 to June 2008 in the Medical Unit-111, Jinnah Postgraduate Medical Center, Karachi. The study was designed to include patient's demographics [age, occupation, marital status and education], clinical information and duration of the visits to roadside barbers with an approximate frequency of shavings per month. The patients with history of>3 visits to a roadside barber during the last six months were included in the study. Whereas, the patients with history of liver disease, blood transfusion, surgery, dental treatment, tattoo marks, intravenous drug use, on regular injectable medicine [like insulin, etc], multiple sexual partners and on haemodialysis were excluded from the study. A blood sample was collected at the time of admission and the screening for HCV-antibodies was done by Enzyme Linked Immuno-Sorbant Assay [ELISA]. A total of 184 male patients were included in the study. The mean age+ SD of the patients under the study was 33.8+13.2 years. The majority of study patients were uneducated and belonged to low socioeconomic group. Out of 184 patients, 70 [38%] were found to be HCV-antibodies reactive. In comparison to younger patients [age<40 years], the older patients as well as those with history of longer duration of visits to roadside barbers had high prevalence of HCV-antibodies reactivity, P.015 and P.02 respectively. There was no statistical significant difference for the prevalence of HCV-antibodies reactivity among the different socioeconomic groups, educational level and marital status. In the present study, it is concluded that the sharing of unsterilized shaving kits and used blades by roadside barbers are the main sources for the transmission of HCV. The transmission rate of HCV infection increases with the duration and multiple exposures for shaving