Compliance with therapy in patients with chronic hepatitis C - Associations with psychiatric symptoms, interpersonal problems, and mode of acquisition

Tolerance of interferon-alpha therapy for hepatitis C is often poor and med ication is expensive. Compliance with diagnostic procedures and, even more important, with medical treatment is obviously critical to minimize the rat e of dropouts and to maximize cost efficiency. Moreover, a good concordance with scheduled follow-ups is important for early recognition and treatment of interferon-associated side effects. Therefore, we investigated psychiat ric symptoms, interpersonal problems, different modes of acquisition, and s ociodemographic factors in HCV-infected patients as possible predictor vari ables of good versus poor compliance. In a longitudinal study, 74 patients with chronic hepatitis C (CHC) who fulfilled the criteria for treatment wit h interferon (IFN)-alpha -2b with or without ribavirin were investigated pr ospectively to identify those at risk for poor compliance during IFN medica tion. To assess predictive factors, we used both IIP-C (Inventory of Interp ersonal Problems) and SCL-90-R (Symptom Check List 90 Items Revised) as psy chometric instruments. Sociodemographic and somatic variables as well as co mpliance during IFN therapy were also evaluated. Poor compliance before or during medication was demonstrated by 23% (N = 17) of HCV patients. Sociode mographic factors and mode of acquisition, particularly former intravenous drug (IVD) abuse were not significantly linked with compliance. Logistic re gression analysis demonstrated that the subgroup of patients with complianc e problems was best identified by both pretherapeutic psychiatric symptoms and interpersonal problems. Predictive value was best and significant for a nger-hostility (P = 0.009), intrusive (P = 0.014), depression (P = 0.015), and phobic anxiety (P = 0.049). Adopting this statistical prediction model, sensitivity was 47.1%, but specificity reached 98.3%. In total, 86.5% of c ases were classified correctly. In situations of unclear indication for IFN therapy, psychological variables assessment of before the beginning of tre atment may represent an additional decision-making factor.