Due to neuropsychiatric side effects, mental disease was a major obstacle to HCV therapy during the Interferon (IFN) treatment period. While direct acting antivirals (DAA) are more tolerable, patient-level limitations remain. For a study, researchers sought to determine how depressed symptoms affected the time it took for HIV–HCV co-infected people to start HCV therapy during the IFN (2003–2011) and second-generation DAA (2013–2020) periods.

They used data from the Co-infection Cohort, a multicenter prospective cohort, and its Food Security (FS). They used a random forest classifier to predict Center for Epidemiologic Studies Depression Scale-10 (CES-D-10) classes for depressed symptoms suggestive of depression risk, and they adjusted for misclassification using predictive value-based record-level correction. To examine the influence of depressed symptoms on treatment start among HCV RNA-positive patients, they utilized marginal structural Cox proportional hazards models with inverse weighting for competing risks (death).

In the IFN and DAA periods, we had 590 and 1,127 participants, respectively. Between the IFN and DAA eras, the treatment start rate increased from 9 (95% CI: 7–10) to 21 (9% CI: 19–22) per 100 person-years. Treatment initiation was lower in the IFN period relative to those without depressive symptoms (hazard ratio: 0.81 (95% CI: 0.69–0.95)) and greater in the DAA era (1.19 (95% CI: 1.10–1.27)).

In the DAA era, depressive symptoms did not appear to be a barrier to starting HCV therapy in the co-infected population. Patients with depressive symptoms had a greater likelihood of therapy start, indicating that those who were previously unable to tolerate IFN are now able to get treatment.