coping with hiv and hep c by bill coleman phd. people with hepatitis c as well as hiv are at...

COPING WITH HIV AND HEP C By Bill Coleman PhD

People with hepatitis C as well as HIV are at increased risk for mental health issues compared with people in the general population.

Living with HIV affects your mood. Living with the hepatitis C virus doesnt just take a toll on your liver. It can also affect your mind. Negative mental health effects can also stem from your hepatitis C treatment.

Our mental health is key to our sense of well-being, and HCV can affect our brain in many ways. Mental stress is very bad on the liver, which can worsen symptoms of HCV. Mental and physical health of HCV+ people are strongly related. Hepatitis C viruses have been known to cross the blood-brain barrier. Liver damage can also cause toxins to remain in the blood, eventually causing damage to the brain. Psychotropic (antidepressants - antianxiety drugs} can also interact dangerously with other drugs such as those taken to fight HCV and its symptoms. Some people with HCV may already have mental health and addiction issues which are made worse as the virus does its damage.

Psychiatric problems are significantly more prevalent in hepatitis C and HIV - infected people. Mental health problems are associated with an increased risk of acquiring hepatitis C and HIV. Symptoms such as depression, fatigue can appear in HIV+ persons. Cognitive impairment (Brain Fog) could be due to the effect of hepatitis C on brain chemistry or inflammation. Hepatitis C and HIV infections are associated with stigma, anxiety and reduced quality of life, leading to high levels of psychosocial distress. There is evidence that hepatitis C alters the metabolism of the central nervous system.

EMOTIONAL SIDE EFFECTS OF HIV/HEP C

BRAIN FOG IN HEP C

HCV doesnt just affect the liver. It can have profound affects of the brains of HCV+ people. In chronic HCV, brain function is often impaired, characterized by a syndrome combining mild confusion, forgetfulness, and difficulty concentrating or focusing, which many refer to as Brain Fog. This can range from very mild forms which no one really notices except the HCV+ person experiencing the cognitive difficulty, all the way to a gray area between severe Brain Fog and mild Encephalopathy. Encephalopathy

If you have Brain Fog: Consult your liver specialist, nurse, and/or mental health professional for advice and support. Do what you can to de-stress your life this will improve both your physical and mental health! Join a HCV+ peer support group. Exercise regularly, preferably with others. Take pleasure in simple things you enjoy and excel at; dont be hard on yourself.

DEPRESSION Common in HIV and HEP C

DEPRESSION Anyone can suffer from depression, but with HIV and HCV it is more common than in the general population, and often develops or worsens during treatment.

Addressing mental health symptoms is important to antiviral treatment success. Close adherence to and completion of multiple-week (HEP C) and ongoing adherence with (HIV) therapy are required for achieving treatment success (Sylvestre & Clements, 2007).Sylvestre & Clements, 2007

Depression is a very common symptom of chronic hepatitis C. Key points: Drugs used for depression can be very bad for the liver. Consult with your pharmacist, mental health professional, liver specialist, and/or family physician to make sure you are not damaging your liver unnecessarily. Depression can cause stress, which can damage your liver, and liver damage can even make your depression worse, resulting in a vicious cycle! HCV treatment is known to make depression worse, or cause it in people who never experienced it before. If this happens, get help immediately. If you or a friend or family member is experiencing severe depression, never hesitate to ask for help. There is nothing to be ashamed of, and people are there whose job it is to help you.

Mood changes, including anxiety and irritability, can come with a diagnosis of HIV as well as hepatitis C. These same mood changes may also be a side effect of hepatitis C treatment. For example, irritability is an under- acknowledged side effect of interferon therapy, according to a study published in the Journal of Clinical Nursing in 2011.study

People who never had problems with anxiety, depression, or irritability might experience these as a result of treatment for chronic hepatitis and HIV, and stable patients with previous mental health problems might have exacerbations.chronic hepatitis Some early symptoms of treatment-related depression might also mimic opioid withdrawal. This can complicate clinical management for the large subset of patients with chronic hepatitis C who have a history of opioid injection drug use (Schaefer & Mauss, 2008).hepatitis CSchaefer & Mauss, 2008

Sleep disturbances are common among people with Hep C, affecting about 60 percent of people with the infection, according to the Hepatitis Monthly research review. Sleep disturbances are also common with HIV+ persons. Some sleep issues may be due to psychiatric problems, substance abuse issues, or advanced liver disease. In turn, not getting proper rest can increase your risk for depression, anxiety, and not feeling well in general.

Help lift your mood by seeking social support from loved ones and others who also have the condition. If the feelings of sadness become overwhelming, it may be time to seek medical help. Its important to deal with any mental health issues, especially depression, because they can get in the way of faithfully taking medications. It also increases the risk for engaging in unhealthy behaviors.

Hepatitis C and HIV is often contracted through needles or other equipment used to inject drugs, and many people with hepatitis C and HIV also struggle with substance use as well as the mental health issues that can go hand-in- hand with that use. Pre-existing mental health issues can increase risk for substance abuse and risk of getting HIV and hepatitis C.

HIV MEDS AND RECREATIONAL DRUGS

ALCOHOL Excessive alcohol use may weaken the immune system function and threatens the long-term benefits of ARV therapy. Alcohol can increase blood levels of abacavir (Ziagen, fact sheet 416). abacavir (Ziagen, fact sheet 416) Chronic alcohol use affects treatment adherence by interfering with a persons ability to stick to a regular ARV regimen. Alcohol use may increase the risk of pancreatitis when used with didanosinedidanosine

COCAINE Although interactions between cocaine and ARVs are unlikely to increase cocaine toxicity, the cocaine use may decrease ARV effectiveness by diminishing adherence.

CRYSTAL METH, METHAMPHETAMINE, GLASS, TINA A recent study found that gay men who use crystal meth have five times the risk of HIV infection as non-users. Serious and dangerous drug interactions are highly likely. When methamphetamine is used with ritonavir (Norvir, fact sheet 442), amphetamine levels can double or triple. ritonavir (Norvir, fact sheet 442)

ECSTASY/MDMA Ecstasy uses the same liver pathway as protease inhibitors. This can cause very high levels of ecstasy in the body of people taking protease inhibitors.. Ecstasy can also increase the risk of kidney stones when used with indinavir (Crixivan, fact sheet 441) due to dehydration.indinavir (Crixivan, fact sheet 441)

GHB This drug is primarily metabolized by the liver. There are no known interactions between GHB and ARVs. Protease inhibitors may increase GHB levels.

KETAMINE (K, SPECIAL K) This drug is primarily metabolized by the liver. All protease inhibitors may cause high levels of ketamine. This could cause hepatitis. To date, there are no case reports or studies of interactions between ketamine and ARVs.

MARIJUANA There are no known interactions between marijuana and ARVs. Interactions may be greater if marijuana is eaten rather than smoked. Use with protease inhibitors may increase effect of marijuana.

METHADONE AND HEROIN Methadone increases by roughly twofold the levels of AZT, some people believe that people taking both drugs need only take half the standard dose of AZT to get the same anti-HIV effect. (Check with your MD.)

METHADONE AND HEROIN The NNRTIs efavirenz and nevirapine speed up methadone metabolism and this can result in substantially decreased levels of methadone

METHADONE AND HEROIN Patients began to report opiate withdrawal symptoms eight to ten days after starting nevirapine, but it is not recommended that methadone dosage be increased at the same time as starting nevirapine. Instead, it may be better to monitor withdrawal symptoms and increase the methadone dose if withdrawal does begin to occur. 4 4

METHADONE AND HEROIN Ritonavir reduces blood levels of both methadone and heroin. Ritonavir-boosted protease inhibitors have shown widely varying effects on methadone levels. So the best advice is to monitor carefully for methadone withdrawal and increase the dose accordingly.

RECREATION DRUGS AND HIV Some doctors recommend leaving as many hours as possible between a dose of a protease inhibitor and a drug such as Ecstasy. There is no hard evidence that this will reduce the risk of an interaction, but it is unlikely to increase the risk either. Skipping the protease inhibitor dose is never a good idea, as it may lead to drug resistance.

The impact of psychosocial support on HCV treatment outcomes was evaluated and found that while patients with mental health and substance use disorders take longer to initiate treatment.... (This may also be true of HIV+ persons.) Psychosocial support helps these patients access and complete treatment with outcomes similar to the general patient population.

Many patients with HIV and HCV infection had complex neuropsychiatric and psychosocial problems. These problems are challenges for management of the infection, and affects the patients care significantly and might alter the course of the disease. A multidisciplinary approach, a supportive environment, and a nonjudgmental healthcare team are required for optimal medical and psychosocial management of patients.

Neuropsychiatric side-effects of pegylated interferon Hepatitis C therapy based on pegylated interferon is associated with increased incidence of depression, fatigue, sleep disturbances, fatigue, irritability, cognitive disturbances and thoughts of suicide. Therapy is less frequently associated with mania, confusion, psychotic syndromes, attempted suicide and aggressive or compulsive behaviour. Symptoms including fatigue, sleep disturbances and decreased appetite appear almost immediately after treatment is started. Depression and cognitive problems usually emerge between weeks 4 and 24 of therapy and are at their most intense between weeks 8 and 16. Therapy based on pegylated interferon is associated with changes in neurobiology. Changes to the serotonin and dopamine metabolism may be an important cause of depression and fatigue. Alterations in brain chemistry and toxicities may be contributing towards cognitive changes European guidelines on management of mental health for people with hepatitis C

Risk factors for depression or suicide associated with pegylated interferon Depression during a previous course of therapy based on pegylated interferon. Depression before treatment was started. Sleep problems during therapy. The emergence soon after starting therapy of sleep problems or loss of appetite. Stress or lack of social support before initiating treatment. A previous psychiatric history may be a risk factor for suicide.

coping with hiv and hep c by bill coleman phd. people with hepatitis c as well as hiv are at...

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