Re: Severe Fatigue and Age but Not Neurocognitive Dysfunction or............

[Guest guest]

Thank You SuZie sometimes i just do NOT understand the Fatigue and you just

helped a great Deal :)and yes i want tooooo come back as a Cat to but only in a

good Home i got a Calico from the Humane Society and she is in training to

to train me ,Page

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> Severe Fatigue and Age but Not Neurocognitive

> Dysfunction or Liver Disease Significantly Impair

> Quality of Life in HCV Patients,

> Particularly among Women

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> By Baker, PhD

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> Fatigue has emerged as one of the most significantly disabling side effects of

individuals with hepatitis C virus (HCV) infection. HCV patients complain of the

debilitating effects of fatigue at all stages of hepatitis C [1]. Despite the

high prevalence of fatigue and the repeated complaints about it from affected

patients, there are scant data in the medical literature on this subject. As a

result, the pathophysiology of fatigue in patients with hepatitis C is not well

understood.

> While chronic liver inflammation might be expected to be causally linked to

fatigue, there is no correlation between cytokine concentrations and fatigue

severity. [2] In addition, although often viewed as a result of the progression

of liver disease, the severity of fatigue is not strongly linked to the

biochemical and histological activity of hepatitis [3].

> Recent research however shows clear associations between fatigue and female

sex, age over 50 years, extrahepatic symptoms of HCV infection, and cirrhosis

[4].

> Ludwig Kramer, MD, and colleagues at the Department of Medicine IV, Medical

University Vienna, in Vienna , Austria have demonstrated in earlier studies the

potential neurocognitive aspects of HCV-related fatigue. The results of new

research by these Austrian researchers appear in the October 2005 supplement of

the journal AIDS [5]. Summarized and discussed here are the major findings of

this new study and their implications for management of patients with chronic

hepatitis C.

> The Austrian researchers investigated the hypothesis that severity of fatigue

rather than subclinical cognitive dysfunction has an independent effect on

HCV-associated impairment of health-related quality of life (HRQL). To assess

the severity of fatigue, the researchers utilized both the fatigue impact scale

(FIS) [6] and the more recently developed brief fatigue inventory (BFI) [7], and

compared their respective association with HRQL measures and clinical data.

> The Austrian investigators evaluated 120 untreated patients referred to their

liver clinic with chronic hepatitis C (aged 45 ± 12 years). Inclusion criteria

were age between 18 and 80 years and presence of anti-HCV antibodies and HCV RNA

in serum. Excluded from the study were individuals with decompensated cirrhosis,

alcoholic liver disease, cryoglobulinemia, liver transplantation, other

bacterial or viral infections, renal failure, insulin-treated diabetes,

cerebrovascular disease and a current or past history of neurological or

psychiatric illness including attention and learning deficits, medication with

tranquillizers or antidepressants, or a history of alcohol or injection drug

abuse within 6 months before the study.

> Results

> Relative to healthy controls, HCV-infected patients showed significant levels

of fatigue (Fatigue Impact Scale, 49 versus 26 points, brief fatigue inventory,

3.0 versus 1.6 points, P < 0.001).

> Fatigue impact scale and brief fatigue inventory scores were highly

correlated (P < 0.001), demonstrating concurrent validity.

> Severity of fatigue and age were the only factors independently associated

with the impairment of HRQL (P < 0.001).

> Fatigue was not related to the severity of hepatitis or the degree of

subclinical brain dysfunction.

> Based on the findings, the authors conclude, “In untreated patients with

chronic HCV infection, fatigue severity and age but not neurocognitive

dysfunction or hepatic function are independently associated with impaired

HRQL.â€

> “Both the fatigue impact scale and the brief fatigue inventory are suitable

tools to assess the subjective burden of fatigue.â€

> Discussion

> This study demonstrates that fatigue severity and age are independently

associated with impairment of HRQL in chronic HCV infection. It is arguably the

first study to show that fatigue, not the severity of liver disease, sex or

neurocognitive dysfunction, is a significant factor in the pathogenesis of

HCV-associated HRQL reduction.

> Because the severity of HCV-associated liver disease is only weakly associated

with fatigue and effects on HRQL persisted even after liver transplantation [8],

“psychological factors leading to fatigue clearly need to be identified,â€

note the study authors.

> The authors also found that drug abuse was one of the main factors associated

with HRQL impairment in patients co-infected with HIV and HCV. In addition,

women, in particular, appeared to be significantly affected by fatigue.

> The authors write, “Given that most patients with HCV infection, and

particularly those with additional risk factors such as HIV infection, will

exhibit some degree of fatigue [9], our findings have potential implications:

The treatment of fatigue will probably become a therapeutic requirement for

healthcare providers dealing with hepatitis C.â€

> Treatment to alleviate fatigue will probably eventually involve both

pharmacological and non-pharmacological components. Unfortunately, the currently

available psychostimulants have a high potential for dependency. “Modafinil

needs to be investigated in patients with HCV infection,†they emphasize [10].

> On a more hopeful note, the authors point out that structured exercise

effectively improves HRQL in patients with the chronic fatigue syndrome, cancer,

and AIDS, “and may be the best treatment option currently available [11,12]

[for fatigue in chronic HCV patients].â€

> A randomized trial to investigate a structured exercise program in patients

with HCV infection is ongoing.

> In summary, the authors write, “Fatigue severity and age but not

neurocognitive dysfunction or hepatic function are associated with impaired HRQL

in patients with untreated chronic HCV infection.â€

> “Female patients were particularly affected by fatigue. These findings

stress the need for effective therapeutic interventions to ameliorate the burden

of fatigue in patients with HCV infection.â€

> 11/04/05

> Primary Source

> L Kramer and others. Relative impact of fatigue and subclinical cognitive

brain dysfunction on health-related quality of life in chronic hepatitis C

infection. AIDS 19(Suppl 3): S85-S92. October 2005.

> References

> 1.      Kenny-Walsh E. Clinical outcomes after hepatitis C infection from

contaminated anti-D immune globulin. Irish Hepatology Research Group. N Engl J

Med 1999; 340:1228-1233.

> 2.      Gershon AS, Margulies M, Gorczynski RM, Heathcote EJ. Serum

cytokine values and fatigue in chronic hepatitis C infection. J Viral Hepat

2000; 7:397-402.

> 3.      Jamal MM, Soni A, Quinn PG, Wheeler DE, Arora S, ston DE .

Clinical features of hepatitis C-infected patients with persistently normal

alanine transaminase levels in the Southwestern United States . Hepatology 1999;

30:1307-1311.

> 4.      Poynard T, Cacoub P, Ratziu V, Myers RP, Dezailles MH, Mercadier

A, et al. Fatigue in patients with chronic hepatitis C. J Viral Hepat 2002;

9:295-303.

> 5.      Kramer L, Hofer, H, Bauer, E et al. Relative impact of fatigue

and subclinical cognitive brain dysfunction on health-related quality of life in

chronic hepatitis C infection. AIDS 2005; 19(Suppl 3): S85-S92.

> 6.      Fisk JD, Ritvo PG, Ross L, Haase DA, Marrie TJ, Schlech WF.

Measuring the functional impact of fatigue: Initial validation of the fatigue

impact scale. Clin Infect Dis 1994; 18(Suppl. 1):S79-S83.

> 7.      Mendoza TR, Wang XS, Cleeland CS, sey M, BA, Wendt

JK, et al. The rapid assessment of fatigue severity in cancer patients: use of

the brief fatigue inventory. Cancer 1999; 85:1186-1196.

> 8.      De Bona M, Ponton P, Ermani M, Iemmolo RM, Feltrin A, Boccagni P,

et al. The impact of liver disease and medical complications on quality of life

and psychological distress before and after liver transplantation. J Hepatol

2000; 33:609-615.

> 9.      Soriano V, Sulkowski M, Bergin C, Hatzakis A, Cacoub P, Katlama

C, et al. Care of patients with chronic hepatitis C and HIV co-infection:

recommendations from the HIV-HCV International Panel. AIDS 2002; 16:813-823.

> 10. Becker PM, Schwartz JR, Feldman NT, RJ. Effect of modafinil on

fatigue, mood, and health-related quality of life in patients with narcolepsy.

Psychopharmacology (Berl) 2004; 171:133-139.

> 11. J, S, Reul-Hirche H. Improving the physical status and

quality of life of women treated for breast cancer: a pilot study of a

structured exercise intervention. J Surg Oncol 2004; 86:141-146.

> 12. a BA, Neidig JL, Nickele JT, GL, Parab MF, Fassb RJ. Aerobic

exercise: effects on parameters related to fatigue, dyspnea, weight and body

composition in HIV-infected adults. AIDS 2001; 15:693-701.

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> http://www.hivandhepatitis.com/hep_c/news/2005/ad/110405_a.html

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> Next time I'm coming back as a cat

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