Depression profiles and hepatitis C treatment outcomes among people who inject drugs: The HERO study.

Abstract

Background: Evidence suggests that depression profiles may be differentially associated with healthcare engagement. Relying solely on total scores may limit our understanding of depression among people who inject drugs (PWID) living with hepatitis C virus (HCV). This study aimed to (1) identify latent baseline depression symptom profiles and their correlates in HCV-infected PWID; (2) examine changes in depressive symptoms from baseline to follow-up by symptom profile and HCV cure status; and (3) examine the association between baseline depression symptom profiles and HCV treatment outcomes (adherence, completion, and sustained virologic response (SVR)).

Methods: A secondary data analysis of the HERO Study was conducted with 498 PWID undergoing direct-acting antiviral (DAA) treatment. Latent class analysis classified participants into distinct baseline depression symptom profiles using the Patient Health Questionnaire-9 (PHQ-9). Changes in PHQ-9 scores and adherence were estimated using linear mixed-effects models, and logistic regression tested the impact of baseline depression symptom profile on treatment completion and SVR.

Results: Three depression profiles were identified: Class 1 (n = 63/498) showed no symptoms. Class 2 (n = 148/498) was characterized by sleep difficulties, fatigue, and appetite changes. Class 3 (n = 287/498) endorsed all PHQ-9 items except suicidal thoughts and showed higher rates of urine toxicology tests positive for cocaine. Depression scores post-HCV treatment varied by SVR status, with those who did not achieve SVR showing persistent depression. Adherence, completion, and SVR did not differ across classes.

Discussion: Severe depression among HCV-infected PWID underscores the critical importance of assessing, monitoring, and treating these symptoms during HCV treatment, particularly for those not achieving HCV cure.

Clinical trials number: NCT02824640.