GLOBALLY, hepatitis B virus (HBV) affects approximately 257 million individuals, with close to one million deaths annually attributed to its complications. In the United States alone, over 2 million people are infected each year, and nearly 10 million adults live with resolved HBV infection. These individuals, considered to have cleared the virus from their bloodstream (HBsAg negative, HBcAb positive), are often overlooked in both research and clinical monitoring.
A new cross-sectional study, using data from the National Health and Nutrition Examination Survey (NHANES), investigates a previously underexplored area: the relationship between resolved HBV infection and depression. While much research has examined active HBV infection and mental health, this study is among the first to identify a significant association between resolved HBV and an increased risk of depression.
Using a propensity score matched design, the researchers found that individuals with resolved HBV infection were more likely to experience depressive symptoms than those without HBV. The results remained consistent across multiple models and subgroup analyses, suggesting that even after achieving a ‘functional cure’, psychological risks persist.
The study highlights that residual viral elements, such as covalently closed circular DNA in liver cells, may still influence physical and mental health long after the infection appears resolved. Social stigma, fear of reactivation, and concerns over long-term health effects may also contribute to ongoing psychological stress. Additionally, inflammatory pathways linked to liver disease may play a role in triggering or sustaining depression.
Although the study cannot confirm a direct causal relationship, it raises important concerns about the long-term mental health of individuals with resolved HBV infection. Given the evidence, routine psychological assessment and support should be considered for these patients. Further longitudinal studies are needed to better understand the mechanisms involved and to guide more comprehensive care.
This research emphasises the need for holistic approaches to managing HBV, not only focusing on viral suppression but also on the enduring impact on patients’ mental well-being.
Reference
Yang Y et al. Association between resolved hepatitis B virus infection and femoral and spinal bone mineral density in American adults: a cross-sectional study. Front Endocrinol (Lausanne). 2023;14:1237618.
