Reduction in Depressive Symptoms in People who Inject Drugs who Are Cured of Hepatitis C Virus Infection: The HERO Study
Authors: Pericot-Valverde Irene , Lopes Snehal S , Nahvi Shadi , Thrasher James F , Karasz Alison , Taylor Lynn E , Mehta Shruti H , Lum Paula J , Tsui Judith I , Page Kimberly , Feinberg Judith , Kim Arthur Y , Norton Brianna L , Arnsten Julia H , Fernandez-Artamendi Sergio , Heo Moonseong , Litwin Alain ,   HERO Research Group, Litwin Alain H , Heo Moonseong , Pericot-Valverde Irene , Walker Hagan , Coleman and Ashley , Mehta Shruti H , Borsuk Courtney , Dickerson Brian , Falade-Nwulia Oluwaseun , Fingerhood Michael , Haselhuhn Taryn , Mason Angela , Moon Juhi , Olsen Yngvild , Walters and Vickie , Kim Arthur Y , Roche Jillian M , Schmitt William , Lijewski Virginia , Pitts Anita , Raji Syeda , Silva Taniya , Evans Fiona , Koene Hope , Brown Joelle , Norton Brianna , Agyemang Linda , Arnsten Julia , Karasz Alison , Meissner Paul , Lora Kiara , Hidalgo Jennifer , Soloway Irene , Jefferson Karen , Wong Joyce , Kermack Andrea , Stein Melissa , Joseph Gilian , London Karyn , Allen Lincoln , Marte Venecia , Vera Tatiana , Alvarez and Romy , Mckee M Diane , Lum Paula J , Stein Ellen S , Luetkemeyer Anne F , Cullen Caycee , Gill Gurjot , Tierney Hannah , Shapiro Scott , Azari Soraya , Eveland Joanna , Berrner Daniel , Grey Pauli , Akerley and Jordan , Page Kimberly , Wagner Katherine , Davis Herbert , Murray-Krezan Cristina , Jacobsohn Vanessa , Anderson Jessica , Taylor Lynn E , Tashima Karen , Sprecht-Walsh Sophie , Thomas Aurielle , Hordes Melissa , McGregor Danielle , Duryea Patrick , Weenig and Kathryn , Tsui Judith I , Blalock Kendra L , Kim Hyang Nina , Ramchandani Meena S , James Jocelyn R , Peavy K Michelle , Grekin Paul , Ninburg and Michael , Feinberg Judith , Wilkinson Samuel , Thomas Danielle , Kelley Lacey , Calkins Andrea , Henry Gabrielle 
Published: October 2023

Abstract

Background
Depressive symptoms are prevalent among people who inject drugs (PWID) and people with hepatitis C virus (HCV). We examined changes in depressive symptoms among HCV-infected PWID following direct-acting antiviral treatments to evaluate whether these changes differed by history of depressive symptoms, substance use, or HCV treatment outcome.

Methods
We conducted a secondary analysis of the HERO Study (NCT02824640), a pragmatic randomized clinical trial among PWID, to test the effectiveness of HCV care models. Depressive symptoms (primary outcome) were measured using the Patient Health Questionnaire (PHQ-9) at baseline, end of treatment (EOT), and at follow-up 12 and 24 weeks after EOT. Sustained virologic response (SVR) was defined as undetectable HCV RNA at ≥12 weeks following EOT. Baseline drug use was defined as having a positive urine screening test for amphetamine, methamphetamine, benzodiazepine, cocaine, cannabis, opiate, or oxycodone.

Results
The sample (n = 498) was 72.3% male, 64.2% White, and on average 43.9 years old. In patients who achieved SVR (F(3432) = 4.58; P = .004) and those with drug use at baseline (F(3478) = 5.11; P &lt; .01), PHQ-9 scores significantly declined over time, with scores lower at EOT and both follow-ups as compared with baseline. Mean PHQ-9 scores at EOT and follow-ups were significantly lower than at baseline, except for those with no depression or mild depression at baseline.

Conclusions
This study showed that HCV treatment in PWID is associated with sustained declines in depression up to 24 weeks post-treatment among those who achieve SVR and that drug use does not interfere with improvement in depressive symptoms.