VIRAL HEPATITIS Psychological, lifestyle and social predictors of hepatitis C treatment response: a systematic review Victoria A. Sublette 1 , Mark W. Douglas 2,3 , Kirsten McCaffery 1 , Jacob George 2 and Kathryn Nicholson Perry 4 1 School of Public Health, University of Sydney, Sydney, NSW, Australia 2 Storr Liver Unit, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Westmead, NSW, Australia 3 Centre for Infectious Diseases and Microbiology, Sydney Emerging Infections and Biosecurity Institute, University of Sydney and Westmead Hospital, Westmead, NSW, Australia 4 Centre for Health Research & School of Social Sciences and Psychology, University of Western Sydney, Penrith South, NSW, Australia Keywords HCV treatment – hepatitis C – hepatitis C treatment outcomes – hepatitis C treatment predictors – systematic review Correspondence Dr. Mark W. Douglas, Storr Liver Unit, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Westmead, NSW 2145 Tel: +61 2 9845 7705 Fax: +61 2 9635 7582 e-mail: mark.douglas@sydney.edu.au Received 7 November 2012 Accepted 13 February 2013 DOI:10.1111/liv.12138 Liver Int. 2013: 33: 894–903 Abstract Background: To increase cure rates for Hepatitis C, barriers to treatment adherence and completion must be identified and overcome. Aims: This study systematically reviewed evidence on the psychological, lifestyle and social determinants of achieving viral eradication with antiviral ther- apy. Methods: An electronic search strategy was used to identify relevant studies that examined psychological, lifestyle and social factors related to achieving a sustained virological response (SVR). Results: Thirty-four stud- ies that matched our criteria were identified. Of the factors that predict response to treatment, Asian ethnicity was an independent predictor of SVR. We found an indirect relationship between diet and SVR, with non-respond- ers to treatment consuming more polyunsaturated fatty acids, fats and carbo- hydrates than those who attained SVR. The effect of alcohol consumption relied on the amount consumed; fewer than 30 grams daily had no effect on SVR, whereas >70 grams daily had an adverse impact on a patient’s ability to achieve SVR, with termination rates up to 44% in those who drank >2 drinks a day. Patients with psychiatric illnesses had comparable SVR rates to controls if they continued psychological therapy (average 42%), although discontinuation rates were high with 11 studies reporting rates from 14 to 48%. Conclusions: There are major gaps in current knowledge of the impact of variables such as diet, exercise, attitudes and coping skills on cure rates in chronic Hepatitis C. Those who drink limited amounts of alcohol or have psychiatric disorders should be offered treatment for their disease, with adjunctive education and support to improve treatment completion. Study Highlights What is current knowledge? • Known host and viral factors can predict up to 50% of the variability in Hepatitis C treatment efficacy • Patients with psychiatric illness and those who drink alcohol are often excluded from treatment and clinical trials. What is new here? • Fewer than three drinks a day of alcohol does not impact treatment outcome • Patients with psychiatric illnesses have comparable SVR rates to controls if they complete the therapy • The impact of diet, exercise and socioeconomic sta- tus on SVR rates is under-researched. Chronic Hepatitis C (CHC) is a major public health concern, with approximately 170 million people, or 3% of the world’s population, infected with the Hepatitis C virus (HCV). Untreated, it can lead to cirrhosis, hepato- cellular carcinoma or to liver transplantation (1). CHC can be cured, with treatment success defined as a Sus- tained Virological Response (SVR), where the virus remains undetectable in the blood 6 months after treat- ment completion (2). The overall SVR rate in major clinical trials of PEG-interferon and ribavirin is around 60%, but can be substantially lower in ‘real world’ set- tings (3). Most research to date has focused on the med- ical and physiological predictors of treatment outcomes, identifying many histological, virological and genetic predictors of SVR, including HCV genotype and viral load, the extent of liver fibrosis and polymorphisms Liver International (2013) © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 894 Liver International ISSN 1478-3223