PEOPLE who inject drugs (PWID) face a high prevalence of anxiety, with approximately two-thirds self-reporting symptoms in the past year. This association is well-documented, with substance use both contributing to and exacerbating anxiety symptoms. Many individuals use illicit substances as a means of self-medicating their anxiety, yet this coping strategy is linked to poorer quality of life and a heightened risk of suicide attempts. Additionally, PWID are frequently exposed to stressful environments such as homelessness, legal issues, and sex work, which further perpetuate anxiety disorders.
Chronic hepatitis C virus (HCV) infection is also highly prevalent in PWID, with nearly 40% affected globally. In this population, moderate to severe anxiety is common, highlighting the intersection of infectious disease and mental health. Emerging research has suggested that HCV treatment with direct-acting antivirals (DAA) may influence anxiety symptoms. While some studies have found no change in anxiety from baseline to 12 weeks after the end of treatment, others have reported significant improvements, particularly in those achieving sustained virologic response (SVR). However, previous studies often fail to account for individuals actively injecting drugs at the time of treatment, limiting generalisability.
This study aimed to address these gaps by exploring anxiety changes among HCV-infected PWID undergoing DAA treatment, with follow-up extending to 168 weeks. It further examined whether these changes varied by SVR status, baseline anxiety severity, and benzodiazepine use. The findings indicated that participants who achieved SVR experienced a significant reduction in anxiety scores at all follow-up points. However, overall anxiety scores did not differ significantly between those who were cured and those who were not. Notably, within-group changes showed that anxiety declined consistently in those who achieved SVR, whereas those who remained HCV-positive did not show sustained improvement beyond week 24.
These findings reinforce the complex relationship between HCV treatment and mental health outcomes in PWID. While achieving viral clearance appears to be associated with reduced anxiety, further research is needed to disentangle the effects of treatment from other factors influencing mental health. Understanding these dynamics can guide more comprehensive care strategies for PWID, integrating mental health support alongside infectious disease treatment to improve long-term outcomes.
Reference
Obeysekare J et al. Improvement in anxiety symptoms during treatment of Hepatitis C in people who inject drugs: The HERO study. Drug Alcohol Depend. 2025;270:112592.
