الفهرس 
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Abstract
Unfortunately, Egypt is one of the countries with the highest prevalence of HCV infection, it reached 14.7% for HCV-antibody (Ab) positivity among 15- to 59-year-olds in 2008, with 150 000 new infections per year. HCV treatment consumes 20 percent ($80 million) of Egypt’s annual health budget. In spite of recent introduction of new oral treatment regimen, management by PegIFN alone or as triple therapy will be continue for a significant proportion of the Egyptian patients either due to cost of recent drug, guideline restrictions &/or genotype resistance that relatively minimize the beneficial effects. And so will continue exposed to IFN/Riba side effects that including proportional psychiatric ones, which still show worldwide controversy & great diversity in different publications.
The study aimed to:
(1) Detect the prevalence of psychiatric disturbance in patients with chronic HCV receiving PegIFN/Riba combination in Sohag governate.
(2) Detect the risk factors associated with or related to treatment with PegIFN/Riba. Regimen in a sample of Sohag governate populations.
Research Methodology:
The study included 100 from 167 patients with chronic HCV infection recruited before starting treatment.
The research plan involves assessment of the patient-after accepting to participate-in two stages:
1) Pre-Treatment stage:
For all patients full history taken, complete clinical and neurological examination were done, blood samples were obtained at the start of the study to have a baseline data for (liver and kidney functions, complete blood picture, sugar randomly, serum TSH, quantitative level of viraemia and pregnancy test for married women) and make
the first part of the psychological measurements through the application of standards mini international scale to measure psychological disorders(M.I.N.I) - Hamilton scale for depression (HAM-D), Hamilton scale for anxiety (HAM-A), semistructured interview to assess personality traits based on the five factor theory(SIFFM), checklist revised symptoms-90 (SCL-90-R) to exclude those with ineligible criteria and get the initial measurements to calculate later variables with treatment.
(2Post-treatment stage:
The patients were examined again after12 weeks of continuous treatment of interferon and ribavirin and repeated the same previous clinical assessments, laboratory, and psychological tools, to study statistically the extent of change after treatment.
Our results showed that:
Based on the assessment of M.I.N.I. and after treatment 35% of patients developed major depressive disorder (MDD) with further 43% have subsyndromal significant depressive symptoms, of mild to moderate severity, with positive suicide ideation in 14% of cases but no suicide attempts with no other significant Psychiatric disorders according to MINI inventory.
Highly statistical significant changes in post-treatment results of HAM-D, HAM-A and in subscales of somatization, depression, anxiety, interpersonal sensitivity& Hostility of SCL90-R relative to pretreatment findings.
No statistically significant differences were noted regard hematological, liver enzyme & TSH results of pre- & post-treatment results.
Among sociodemographic factors, a significant correlation were identified with noticed that age of patient (being more elderly), past history of psychiatric illness &family history of Psychiatric illness were detected as statistically significant predictor to occurrence of MDD in HCV patient under PegIFN/Rib. therapy.
In contrast; gender, educational, marital state, occupation, history of substance abuse were detected to has no association with occurrence of MDD as well as all laboratory Findings including pretreatment viraemia.
By 12th week, 48% of our patients show complete clearance of HCV viraemia (N=18,6 % of Female relative to 30,42% of all males), but that statistically wasn’t correlated to development of depression (R=0.57,P=0.45).
Among psychometric parameters; pre-treatment somatic, depressive& hostility subscales of SCL90-R as well as pre-treatment HAM-D & HAM-Awere found to have significant +ve predictor abilities to word MDD under treatment in logistic regression analysis evaluation. But not related to other SCL90-R subscales &personality facets examined by SFFM.
Conclusion and Recommendations
Conclusion
MDD is the major psychiatric disturbance in chronic HCV patients under treatment with combined PegIFN/Rib regimen after 12 weeks of treatment, but not a cause to stop treatment. Being more elderly, with positive past history & family history of psychiatric disturbances & with positive basal or pretreatment depressive & anxiety state was the significant predictor for occurrence of MDD under treatment.
Recommendations:
1- Pre-treatment Screening & Monitoring for depression and suicide ideation should be a routine evaluation for any HCV patient undergoing treatment with IFN therapy
2- Special emphasis & search for subclinical depressive or anxiety symptoms as well as assessment for past history of psychiatric disturbance will provide a good clue for which more attention is needed, saving time, health team effort & cost of further treatment & further investigations.
3- Past history of psychiatric disorders as well as substance abuse shouldn’t be considered as a contraindication to treatment by IFN whenever indicated.
4- Further studies are needed to assess the long-term effects of that combined therapy on those patients. & to evaluate the psychiatric adverse effects of the triple therapy & new oral treatment.