Israel Medical Association Journal

Background: The management of chronic hepatitis C virus (HCV) infection in patients with concurrent severe mental illness and substance use disorder poses significant challenges to treatment initiation, adherence, and completion. Multiple barriers impede successful treatment outcomes in this population, including cognitive impairments associated with mental illness, ongoing psychoactive substance use, and inadequate social and environmental support systems.

Objectives: To implement a treatment program for HCV-infected patients during their psychiatric hospitalization. To establish a multidisciplinary task force comprising a hepatologist, psychiatric ward team (psychiatrists, nurses, social workers), and a project administrator.

Methods: We conducted a retrospective cohort study of patients hospitalized with dual diagnosis (DD) of severe mental illness and substance use disorder who tested positive for HCV antibodies. Patients underwent clinical evaluations and received treatment with direct antiviral agents during hospitalization under the supervision of the joint team. Demographic and clinical characteristics were analyzed.

Results: Between January 2018 and June 2023, 694 DD patients were hospitalized, of whom 119 tested positive for HCV antibodies (prevalence 17.1%). Twenty-seven patients (23%) completed treatment; 17 (63%) achieved confirmed sustained virologic response. Treatment discontinuation occurred primarily post-discharge from the mental health facility. Significant efforts were made to engage community caregivers to maintain continuity of care.

Conclusions: Our findings demonstrate that treating HCV in patients with concurrent severe mental illness and substance use disorder requires collaborative efforts across medical disciplines. This integrated approach during psychiatric hospitalization provides a unique opportunity for initiating and monitoring HCV treatment in this complex patient population.

Background: High prevalence of hepatitis C (HCV) among people with severe mental illness (SMI) is attributed mostly to current or past intravenous (IV) drug use. However, such history may disappear from patient files over time, especially in chronic SMI with prolonged psychiatric admissions.

Objectives: To explore HCV and SMI cross-morbidity (HCV/SMI) in a hospitalized population.

Methods: In this observational, retrospective, historical computerized study we examined prevalence, characteristics, and outcomes of patients with HCV/SMI compared to HCV alone in patients admitted to an Israeli hospital 1 January 2005 to 31 December 2020.

Results: Of 1638 eligible HCV patients, 219 (13.4%) were HCV/SMI. Significantly more native Israelis showed HCV/SMI than HCV alone (36.1% vs. 18.1%, P = 0.013) and history of IV drug use (60.3% vs. 32.4%, P < 0.001). Among Israeli natives, more Jews were SMI/HCV compared to HCV only (67.1% vs. 45%, P < 0.01). Among non-native Israelis, immigration age was lower in SMI/HCV compared to HCV only (27.97 vs. 37.23 years, P < 0.001). No differences were found in mortality or cirrhosis, although HCV/SMI patients experienced earlier mortality compared to HCV alone (61.42 ± 14.3 vs. 72.8 ± 14.6 years, P < 0.001). Cirrhosis among HCV/SMI patients was a risk factor for early mortality (hazard ratio 5.528, 95% confidence interval 3.721–8.213).

Conclusions: HCV/SMI is related to early mortality, particularly with cirrhosis. There is significantly high SMI prevalence in hospitalized HCV patients, representing a unique at-risk population. Identification during hospitalization and medical recommendations at discharge may fill the gaps.