Neuropsychiatric toxicity of antiviral treatment in chronic hepatitis C

Dose-dependent, reversible neuropsychiatric toxicity is reported in up to 3 0-40% of chronic hepatitis C patients treated with 6-12 months of interfero n-alpha or interferon-alpha plus ribavirin combination therapy. Although ri sk factors remain poorly defined, neuropsychiatric side effects may be seve re and dose-limiting in as many as 10-20% of treated patients. Diagnosis re lies upon the detection of clinically apparent neuropsychiatric symptoms an d the emerging use of self-administered mood inventories and questionnaires . The current stepwise approach to management includes evaluation a nd trea tment of systemic side effects, early use of adjuvant medications, and inte rferon-alpha and ribavirin dose reduction or cessation with psychiatric ref erral in selected cases. Although the cellular basis of the neuropsychiatri c toxicity of interferon-alpha remains unknown, several hypothesis involvin g changes in central adrenergic, seratonergic, opioid and neuroendocrine pa thways have been proposed. Recognition and management of the neuropsychiatr ic side effects of antiviral therapy will be of growing clinical importance as additional patients with chronic hepatitis C are treated and longer dur ations of therapy are utilized. Copyright (C) 2000 S. Karger AG, Basel.