Psychiatric management of HIV/HCV-coinfected patients beginning treatment for hepatitis C virus infection: survey of provider practices

Objective: To determine expert clinical practice in the management of psychiatric status of HIV/hepatitis C virus (HCV)-coinfected patients initiating pegylated interferon/ribavirin for the treatment of hepatitis C. Method: Two hundred thirty-six expert providers were identified and invited by email to complete an online anonymous survey. Results: Ninety-two providers (39%) completed the survey, 24 (26%) of whom are psychiatrists. More than one third of providers indicate that they use or offer the option of antidepressant use prophylactically in HIV-positive patients with no past or current depression beginning HCV treatment, and more than three quarters do so in patients with a history of depression but no current symptoms of depression. The most experienced nonpsychiatrist providers were more likely to use antidepressants prior to the start of treatment in HIV-coinfected patients as compared to in HCV monoinfected patients. There is consensus among providers to leave psychiatric medication unchanged in patients currently treated for unipolar depression. Conclusions: Many expert providers prescribe antidepressants to HIV/HCV-coinfected patients initiating Hepatitis C treatment in the absence of symptoms of depression, despite the lack of data supporting this approach in this population. Research is needed to provide an evidence base to guide the optimal psychiatric management of HIV/HCV-coinfected patients beginning hepatitis C treatment.