Interactive Case: Management of an HCV Patient With a History of Depression

December 1, 2008

Select the optimal management choice by clicking one of the answers below. The

CME-certified case will then load, providing feedback on your selection and the

opportunity to test your ability to manage this patient’s disease by continuing

the case.

CME Information | Learning Objectives | Disclosures

Management of a 43-Year-Old HCV-Infected, Treatment-Naive Female With a History

of Major Depression

Faculty: L. Raison, MD

The patient is a 43-year-old white female diagnosed with hepatitis C virus (HCV)

infection 1 year ago after her internist ordered a screening test because of her

relevant risk factors. Further laboratory analysis indicated infection with

genotype 2b HCV and an HCV RNA level of 485,000 IU/mL. She is currently

treatment naive.

The patient likely contracted HCV from intravenous drug use in her early 20s,

but she states that she has been abstinent from drugs and alcohol since she was

27 years of age.

Her medical history is significant for a past history of major depression, with

her first episode occurring at 32 years of age and lasting approximately 1 year.

She had a second episode 3 years ago that was successfully treated with the

selective serotonin reuptake inhibitor (SSRI) citalopram. She self-discontinued

the antidepressant approximately 1 year ago.

The patient presents requesting treatment of her HCV infection and is judged to

be a good candidate for therapy given her moderate HCV RNA level (now measuring

542,000 IU/mL) and infection with genotype 2 HCV.

During a follow-up visit before treatment is initiated, she confides to her

nurse that she has “been losing sleep at night” worrying about her upcoming HCV

treatment. When the physician asks her about this, she bursts into tears and

says her husband is completely unsupportive of initiating HCV therapy and has

been blaming her for contracting HCV in the first place.

Click your choice below.

You will enter the CME-certified program and get immediate feedback. Then you

will be able to continue to manage this patient.

Given this information, how would you manage the patient at this time?

A.

Screen for depressive symptoms before determining the next step

B.

Initiate treatment with an antidepressant before starting HCV therapy

C.

Begin HCV therapy

Jointly sponsored by Postgraduate Institute for Medicine and Clinical Care

Options, LLC.

Release date: September 9, 2008Expiration date: September 8, 2009

Supported by an educational grant from Schering-Plough.

DisclaimerThe materials published on the Clinical Care Options Web site reflect

the views of the reviewers or authors of the CCO material, not those of Clinical

Care Options, LLC, the CME provider, or the companies providing educational

grants. The materials may discuss uses and dosages for therapeutic products that

have not been approved by the United States Food and Drug Administration. A

qualified healthcare professional should be consulted before using any

therapeutic product discussed. Readers should verify all information and data

before treating patients or using any therapies described in these materials.

CCO Hepatitis | RSS | Hepatitis Podcasts | Bookstore | Slideset Downloads

To ensure you receive Clinical Care Options educational materials by

email,please add info@... to your contacts or address book.

White Drive, Suite 110, Reston, VA 20191-5433

Not a member yet? Click here | Unsubscribe from all emails sent from CCO |

Manage email preferences

December 1, 2008