[Chronic HCV infection--disease of body or disease of soul?].

In chronic hepatitis type C fatigue, depression and neuropsychiatric complications of interferon treatment are more frequently reported than in the other parenchymal liver diseases. It contributes to a significant reduction of health related quality of life (HRQL) in those patients. It is believed that psychiatric disorders are the result of brain dysfunction caused by the virus. The hypothesis of neurotropic character of HCV infection is supported by the detection of HCV-RNA in brain tissue, identification of brain-specific quasispecies variants of hepatitis C virus, specific detection of negative-strand viral RNA in the astroglia of patients with acquired-immunodeficiency syndrome and demonstration of metabolic changes resembling HIV-1 encephalopathy in the basal ganglia of patients with chronic hepatitis C. On the other hand there is good evidence that decreased HRQL is directly related to the consciousness of infection and hence, is not of the organic nature. Some authors suggest that patient's worry and anxiety, aggravated by some mass-media and the lack of knowledge, may be a strong determinant of psychological status. Given the complex nature of symptoms in chronic hepatitis C therapy should include education on the natural history of HCV infection and results of treatment, psychotherapy and medical treatment of depression and anxiety. Moreover, antiviral therapy should be considered in highly motivated patients despite lack of clear clinical indications for treatment.