Prevention of Depression in HIV/HCV Co-infected Substance Abuse Patients

• Depression measured by PHQ-9 [ Time Frame: study baseline, treatment visits (0, 2, 4, 8, 12, 18, 24, 30, 36, 42, and 48 weeks) ] [ Designated as safety issue: No ]
• Depression measured by PHQ-9 [ Time Frame: treatment visit 0 week ] [ Designated as safety issue: No ]
• Depression measured by PHQ-9 [ Time Frame: treatment visit 2 weeks ] [ Designated as safety issue: No ]
• Depression measured by PHQ-9 [ Time Frame: treatment visit 4 weeks ] [ Designated as safety issue: No ]
• Depression measured by PHQ-9 [ Time Frame: treatment visit 8 weeks ] [ Designated as safety issue: No ]
• Depression measured by PHQ-9 [ Time Frame: treatment visit 12 weeks ] [ Designated as safety issue: No ]
• Depression measured by PHQ-9 [ Time Frame: treatment visit 18 weeks ] [ Designated as safety issue: No ]
• Depression measured by PHQ-9 [ Time Frame: treatment visit 24 weeks ] [ Designated as safety issue: No ]
• Depression measured by PHQ-9 [ Time Frame: treatment visit 30 weeks ] [ Designated as safety issue: No ]
• Depression measured by PHQ-9 [ Time Frame: treatment visit 36 weeks ] [ Designated as safety issue: No ]
• Depression measured by PHQ-9 [ Time Frame: treatment visit 42 weeks ] [ Designated as safety issue: No ]
• Depression measured by PHQ-9 [ Time Frame: treatment visit 48 weeks ] [ Designated as safety issue: No ]

• Depressive symptoms (measured by Beck Depression Inventory-II) [ Time Frame: study baseline, treatment visits (0, 2, 4, 8, 12, 18, 24, 30, 36, 42, and 48 weeks) ] [ Designated as safety issue: No ]
• Depressive symptoms (measured by Beck Depression Inventory-II) [ Time Frame: treatment visits 2 weeks ] [ Designated as safety issue: No ]
• Depressive symptoms (measured by Beck Depression Inventory-II) [ Time Frame: treatment visits 4 weeks ] [ Designated as safety issue: No ]
• Depressive symptoms (measured by Beck Depression Inventory-II) [ Time Frame: treatment visits 8 weeks ] [ Designated as safety issue: No ]
• Depressive symptoms (measured by Beck Depression Inventory-II) [ Time Frame: treatment visits 12 weeks ] [ Designated as safety issue: No ]
• Depressive symptoms (measured by Beck Depression Inventory-II) [ Time Frame: treatment visits 18 weeks ] [ Designated as safety issue: No ]
• Depressive symptoms (measured by Beck Depression Inventory-II) [ Time Frame: treatment visits 24 weeks ] [ Designated as safety issue: No ]
• Depressive symptoms (measured by Beck Depression Inventory-II) [ Time Frame: treatment visits 30 weeks ] [ Designated as safety issue: No ]
• Depressive symptoms (measured by Beck Depression Inventory-II) [ Time Frame: treatment visits 36 weeks ] [ Designated as safety issue: No ]
• Depressive symptoms (measured by Beck Depression Inventory-II) [ Time Frame: treatment visits 42 weeks ] [ Designated as safety issue: No ]
• Depressive symptoms (measured by Beck Depression Inventory-II) [ Time Frame: treatment visits 48 weeks ] [ Designated as safety issue: No ]
• medication adherence [ Time Frame: study baseline ] [ Designated as safety issue: No ]
• medication adherence [ Time Frame: treatment visits 0 week ] [ Designated as safety issue: No ]
• medication adherence [ Time Frame: treatment visit 2 weeks ] [ Designated as safety issue: No ]
• medication adherence [ Time Frame: treatment visit 4 weeks ] [ Designated as safety issue: No ]
• medication adherence [ Time Frame: treatment visit 8 weeks ] [ Designated as safety issue: No ]
• medication adherence [ Time Frame: treatment visit 12 weeks ] [ Designated as safety issue: No ]
• medication adherence [ Time Frame: treatment visit 18 weeks ] [ Designated as safety issue: No ]
• medication adherence [ Time Frame: treatment visit 24 weeks ] [ Designated as safety issue: No ]
• medication adherence [ Time Frame: treatment visit 30 weeks ] [ Designated as safety issue: No ]
• medication adherence [ Time Frame: treatment visit 36 weeks ] [ Designated as safety issue: No ]
• medication adherence [ Time Frame: treatment visit 42 weeks ] [ Designated as safety issue: No ]
• medication adherence [ Time Frame: treatment visit 48 weeks ] [ Designated as safety issue: No ]
• hepatitis C treatment completion [ Time Frame: study baseline ] [ Designated as safety issue: No ]
• hepatitis C treatment completion [ Time Frame: treatment visit 0 week ] [ Designated as safety issue: No ]
• hepatitis C treatment completion [ Time Frame: treatment visit 2 weeks ] [ Designated as safety issue: No ]
• hepatitis C treatment completion [ Time Frame: treatment visit 4 weeks ] [ Designated as safety issue: No ]
• hepatitis C treatment completion [ Time Frame: treatment visit 8 weeks ] [ Designated as safety issue: No ]
• hepatitis C treatment completion [ Time Frame: treatment visit 12 weeks ] [ Designated as safety issue: No ]
• hepatitis C treatment completion [ Time Frame: treatment visit 18 weeks ] [ Designated as safety issue: No ]
• hepatitis C treatment completion [ Time Frame: treatment visit 24 weeks ] [ Designated as safety issue: No ]
• hepatitis C treatment completion [ Time Frame: treatment visit 30 weeks ] [ Designated as safety issue: No ]
• hepatitis C treatment completion [ Time Frame: treatment visit 36 weeks ] [ Designated as safety issue: No ]
• hepatitis C treatment completion [ Time Frame: treatment visit 42 weeks ] [ Designated as safety issue: No ]
• hepatitis C treatment completion [ Time Frame: treatment visit 48 weeks ] [ Designated as safety issue: No ]

• Depressive symptoms (measured by Beck Depression Inventory-II) [ Time Frame: study baseline, treatment visits (0, 2, 4, 8, 12, 18, 24, 30, 36, 42, and 48 weeks) ] [ Designated as safety issue: No ]
• medication adherence [ Time Frame: study baseline, treatment visits (0, 2, 4, 8, 12, 18, 24, 30, 36, 42, and 48 weeks) ] [ Designated as safety issue: No ]
• hepatitis C treatment completion [ Time Frame: study baseline, treatment visits (0, 2, 4, 8, 12, 18, 24, 30, 36, 42, and 48 weeks) ] [ Designated as safety issue: No ]

The purpose of this study is to determine whether cognitive behavioral therapy (CBT) is effective in the prevention of depression during interferon and ribavirin treatment for hepatitis C infection.

The treatment for active hepatitis C in both HCV mono-infected and HCV/HIV co-infected patients is a long and difficult course, involving combination therapy of interferon and ribavirin for 6 to 12 months, a therapy with significant side effects. Up to 40% of patients being treated will develop depression due to the medication, which in turn leads to discontinuation of therapy and lost opportunities to prevent end stage liver disease. In fact, the presence of depression prior to interferon treatment often excludes patients from receiving interferon therapy, thereby denying them a potentially life-saving treatment. Non-pharmacological therapies such as cognitive behavioral therapy (CBT) have demonstrated efficacy in treating primary depression in numerous studies including in patients under going treatment with chronic medical illness. CBT is a well-established treatment modality and has been shown in several large randomized trials to be as effective, and in some cases more effective, than antidepressants. CBT has also shown efficacy in preventing the development of depression and other emotional disorders in high-risk populations. Offering CBT prior to and during treatment with interferon to non-depressed patients is a unique method that may reduce rates of depression and increase adherence to treatment without exposing patients to the risk of an additional medication.

• Hepatitis C
• Depressive Disorder, Major
• Depressive Disorder
• Depression
• HIV Infections

• Behavioral: Hepatitis C educational support groups
  Hepatitis C educational support groups
• Behavioral: Cognitive Behavioral Therapy skills based group sessions
  Eight CBT group sessions tailored for hepatitis C patients conducted by a clinical psychologist: 3 sessions conducted prior to IFN/ribavirin initiation, 1 session the day of IFN/ribavirin initiation, and 4 sessions during IFN/ribavirin treatment.

• Experimental: CBT skills based group sessions
  Cognitive Behavioral Therapy skills based group sessions
  Intervention: Behavioral: Cognitive Behavioral Therapy skills based group sessions
• Active Comparator: Hepatitis C educational support groups
  Hepatitis C educational support groups
  Intervention: Behavioral: Hepatitis C educational support groups

Inclusion Criteria:

1. >21 years
2. Speak and read English to 5th grade level of higher.
3. Eligible and ready to begin Peg-Interferon and Ribavirin (PEG-IFN/RBV) therapy for HCV at Mount Sinai's Primary Care practice or JMFC
4. HIV infected patients will need to have a CD4 count > 100 and have demonstrated compliance to retroviral therapy
5. Not majorly depressed upon entry to study.
6. Signed informed consent to participate in CBT study

Exclusion Criteria:

1. Majorly depressed (based on administration of the PHQ-9, score considered for Major Depressive Disorder).
2. Admit to actively abusing illicit drugs or alcohol
3. Medical contraindications to a standard course of interferon/ribavirin therapy (eg: severe anemia, uncontrolled congestive heart failure)
4. Less than one year of life expectancy
5. Current participation in CBT related psychotherapy
6. Participation in any psychotherapy beginning less than 6 months before CBT sessions begin.
7. Initiated anti-depressant medication less than 6 months before CBT sessions begin
8. Severe comorbid psychiatric disease including bipolar disorder, severe personality disorder, or psychotic disorder
9. Active suicidal ideation