Psychological, lifestyle and social predictors of hepatitis C treatment response: a systematic review

Authors

  • Victoria A. Sublette,

    1. School of Public Health, University of Sydney, Sydney, NSW, Australia
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  • Mark W. Douglas,

    Corresponding author
    1. Storr Liver Unit, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Westmead, NSW, Australia
    2. Centre for Infectious Diseases and Microbiology, Sydney Emerging Infections and Biosecurity Institute, University of Sydney and Westmead Hospital, Westmead, NSW, Australia
    • School of Public Health, University of Sydney, Sydney, NSW, Australia
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  • Kirsten McCaffery,

    1. School of Public Health, University of Sydney, Sydney, NSW, Australia
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  • Jacob George,

    1. Storr Liver Unit, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Westmead, NSW, Australia
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  • Kathryn Nicholson Perry

    1. Centre for Health Research & School of Social Sciences and Psychology, University of Western Sydney, Penrith South, NSW, Australia
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Correspondence

Dr. Mark W. Douglas, Storr Liver Unit, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Westmead, NSW 2145

Tel: +61 2 9845 7705

Fax: +61 2 9635 7582

e-mail: mark.douglas@sydney.edu.au

Abstract

Background

To increase cure rates for Hepatitis C, barriers to treatment adherence and completion must be identified and overcome.

Aims

This study systematically reviewed evidence on the psychological, lifestyle and social determinants of achieving viral eradication with antiviral therapy.

Methods

An electronic search strategy was used to identify relevant studies that examined psychological, lifestyle and social factors related to achieving a sustained virological response (SVR).

Results

Thirty-four studies that matched our criteria were identified. Of the factors that predict response to treatment, Asian ethnicity was an independent predictor of SVR. We found an indirect relationship between diet and SVR, with non-responders to treatment consuming more polyunsaturated fatty acids, fats and carbohydrates than those who attained SVR. The effect of alcohol consumption relied on the amount consumed; fewer than 30 grams daily had no effect on SVR, whereas >70 grams daily had an adverse impact on a patient's ability to achieve SVR, with termination rates up to 44% in those who drank >2 drinks a day. Patients with psychiatric illnesses had comparable SVR rates to controls if they continued psychological therapy (average 42%), although discontinuation rates were high with 11 studies reporting rates from 14 to 48%.

Conclusions

There are major gaps in current knowledge of the impact of variables such as diet, exercise, attitudes and coping skills on cure rates in chronic Hepatitis C. Those who drink limited amounts of alcohol or have psychiatric disorders should be offered treatment for their disease, with adjunctive education and support to improve treatment completion.

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