Therapy Expectations and Physical Comorbidity Affect Quality of Life in Chronic Hepatitis C Virus In

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From Journal of Viral Hepatitis

Therapy Expectations and Physical Comorbidity Affect Quality of Life in Chronic

Hepatitis C Virus Infection

Posted 01/23/2008

G. Taliani; P. Rucci; E. Biliotti; L. Cirrincione; A. Aghemo; A. Alberti; P. L.

Almasio; D. Bartolozzi; N. Caporaso; R. Coppola; M. Chiaramonte; A. Floreani; G.

B. Gaeta; M. Persico; G. Secchi; I. Versace; S. Zacharia; A. Mele

Abstract and Introduction

Abstract

Summary. Hepatitis C virus (HCV) infection is associated with a significant

reduction of health related quality of life (QOL), the causes and mechanisms of

which are still unknown. To explore whether treatment history could affect QOL,

we examined patients with detectable HCV viraemia who had a different

therapeutic background. Two hundred sixty-four consecutive subjects with chronic

HCV infection and detectable viraemia were enrolled. Of these, 163 were

untreated patients, 43 were relapsers, 58 were nonresponders (NR) to

nonpegylated interferon (IFN) therapy. To assess QOL, three self-report

instruments were employed: the Short Form-36 (SF-36), the Chronic Liver Disease

Questionnaire (CLDQ-I) and the World Health Organization Quality of Life

assessment (WHOQOL-BREF). Clinical and demographic data were collected, and the

QOL scores of HCV-positive patients were compared with those of an Italian

normative sample and healthy controls. Further antiviral treatment was offered

to untreated and relapsed patients but not to NR. All patient groups displayed

lower QOL scores compared with the normative sample and controls. NR displayed

lower QOL scores in several areas compared with untreated patients and

relapsers. In multivariate regression analyses, being NR and having a physical

comorbidity were significantly associated with poorer QOL. Conclusions:

Treatment history and expectations and physical comorbidity may affect QOL in

HCV-positive patients. Untreated and relapsed patients have comparable levels of

QOL and higher scores than NR.

Introduction

Recent studies have documented impairment in health related quality of life

(QOL) in patients with chronic hepatitis C virus (HCV) infection. In particular,

HCV patients are reported to complain of fatigue, musculoskeletal pain, right

upper abdominal discomfort, depression, mental clouding (brain fog) and

perceived inability to function effectively.[1-3] Many studies that compared QOL

in patients with compensated HCV infection vs healthy controls without HCV

indicated that the former patients have consistently diminished QOL scores

across all examined scales.[3,4]

In addition, it is well established that HCV patients who achieve a sustained

viral response (SVR) after successful therapy have an improved QOL compared with

those who failed to respond to the treatment.[5-7] This result has been

interpreted as the consequence of eradication of the infection and suggests that

the infection itself is the true cause of the reduction of the health related

QOL. However, no direct comparison has been performed of the QOL scores of HCV

patients who have never been treated with those of patients who did not respond

to a previous treatment and of patients who relapsed. All these categories of

patients are HCV-RNA positive, nevertheless each of them could have different

perceptions of their clinical condition influenced by anxiety regarding

diagnosis, prognosis and treatment outcome.

The aim of the present study was to evaluate whether HCV-RNA positive patients

with recent diagnosis of their HCV infection who have not yet undergone

antiviral therapy display significantly different QOL scores compared to

patients with long-standing knowledge of HCV infection who underwent antiviral

therapy and failed to achieve a viral response [nonresponders (NR)] or relapsed

after therapy withdrawal (relapsers).

FULL TEXT:http://www.medscape.com/viewarticle/568428?src=mp

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