Fatigue in Patients with Chronic Hepatitis B Living in North America: Results from the Hepatitis B Research Network (HBRN)

Abstract

Background Fatigue is a common symptom of liver disease but not well-characterized in patients with chronic hepatitis B virus (HBV). Aims We assessed the rate of fatigue using a validated instrument in patients with HBV and identified demographic, virologic, and clinical features associated with fatigue in a cross-sectional cohort study from the Hepatitis B Research Network (HBRN). Methods Participants were English and Spanish-speaking adults with chronic HBV who were not pregnant nor on treatment. Fatigue was measured using the PROMIS® Fatigue 7-item Short Form. Results The sample included 948 adults: median age 42; 51% female; 71% Asian; 74% college educated; 77% employed; 41% inactive HBV carriers; 36% with active chronic disease; and 2% with advanced fibrosis, defined as AST-Platelet Ratio Index (APRI) > 1.50. Patients with chronic HBV had a mean fatigue T-score of 46.8 ±SD=7.9, compared to a mean fatigue T-score of 50.0 ± 10 in the U.S. general population (p<.0001). In univariate analyses, greater fatigue was associated with demographic and clinical features such as female sex, lower income, more comorbidities, higher APRI score, and poorer mental health (p<0.05). In multivariate analysis, female sex (p<.001), poorer mental health (p <.001), APRI score (p=.005) and history of diabetes (p=.039) were the strongest independent predictors. Conclusions The frequency of fatigue in this large cohort of North American chronic HBV patients may be equal to or lower than that reported in the U.S. general population. Patients with advanced fibrosis, more comorbidities, and poorer mental health report worse fatigue.

Neuropsychiatric symptoms in hepatitis C patients resemble those of patients with autoimmune liver disease but are different from those in hepatitis B patients

“…Indeed we found a neuropsychiatric profile in the HBV patients that differed from the other groups studied. Our data fit very well with recent findings from Evon et al who assessed the prevalence of chronic fatigue in a sample of 948 HBV infected individuals, of whom a considerable part was inactive carriers (40.7%) and had limited comorbid illnesses (27.8%). Only 2% of participants had advanced fibrosis according to the APRI score.…”

“…10 Recent data revealing a low prevalence of fatigue in HBV patients, however, indicate that chronic liver disease per se is not the source of fatigue. 11 Differences in frequency and presentation of neuropsychiatric symptoms between various liver diseases can be expected considering the differences in aetiology, pathology and course of the disease. This study aimed to describe and compare frequency, extent and characteristics of neuropsychiatric symptoms in noncirrhotic patients with hepatitis C, hepatitis B, autoimmune hepatitis and primary biliary cholangitis.…”

Systemic inflammation and immune cell phenotypes are associated with neuro‐psychiatric symptoms in patients with chronic inflammatory liver diseases

“…Fatigue frequently accompanies chronic inflammatory diseases and cancer . It is also one of the first symptoms in several neurological diseases; eg Parkinson's disease or Multiple sclerosis .…”

Impact of Clinical and Sociodemographic Factors on Fatigue Among Patients With Substance Use Disorder: A Cohort Study From Norway for The Period 2016-2020

“…Among patients with the Hepatitis C Virus (HCV) infection, 50-80% have reported fatigue [9], while 33-88% of those with the Human Immunode ciency Virus (HIV) infection have presented the same symptom [10]. A more uncertain prevalence of fatigue is seen among patients with the Hepatitis B Virus (HBV) [11,12]. In addition, females, patients with lower educational levels, and those with opioid use disorders undergoing Opioid Agonist Therapy (OAT) with methadone or buprenorphine generally have a greater risk of fatigue [13,14].…”