Hepatitis C virus infection: impact on behaviour and lifestyle

Abstract

H 10,000 new infections each year.'Transmission is predominantly via blood, with shared drug injection equipment being the major exposure.2 Little is known about the impact of HCV on behaviour or circumstance of infected individuals. Media reports suggest community concern regarding bloodborne viruses (BBVs) such as HCV, compounded by negative stereotyping of injecting drug users (IDUs). We report on the impact of HCV infection on behaviour, treatment choices and lifestyle in people notified with HCV on the NSW North Coast. MethodsStudy methods have been described prev i o~s l y .~ Briefly, all persons notified with HCV over a 21-month period during 1993 and 1994 were asked to complete a questionnaire examining exposures, therapies and behaviours. Subjects were asked specifically how their infection had influenced behaviours such as alcohol and tobacco intake, and personal circumstances such as relationships and working ability. Details of symptoms were requested on a separate questionnaire from attending medical practitioners with patients' written consent. ResultsKnowledge of potential risk factors for HCV infection varied. Of 467 resident cases who responded, 321 (69%) were aware of potential exposures. Of 398 IDUs, 238 (60%) identified this as an exposure. Forty-three IDUs believed they were infected via other means, 34 did not know and 83 did not state how they were infected. Of 30 non-IDU transfusion recipients, 24 identified this as an exposure. Only 9 of 176 tattooed subjects stated this as a potential exposure.The major reported symptom was fatigue affecting some aspect of daily life, e.g. relationship, work, sleep (n=212; 45%). Some 182 (39%) also reported reduced ability to perform daily duties, 50 (1 1%) nausea and 77 (16%) emotional disturbances (e.g. stress, depression). There was no association between symptoms and hepatitis B virus coinfection (x2=0.21, df=l, p=0.65).Symptoms observed by medical practitioners were reported for a sub-sample of 2 19 subjects (1 17 male, 102 female): 78 (36%) reported fatigue, 47 (21 %) nausea, 46 (21 %) abdominal pain, 28 (13%) loss of appetite, 14 (6%) vomiting, and 7 (3%) jaundice. Fifty-nine (27%) were asymptomatic.Many subjects (n=338; 72%) reported no treatment for HCV, many having not so far returned since diagnosis. Twelve (3%) had used interferon, 37 (8%) anti-emetics, 34 (7%) pain relief and 15 (3%) sedatives. A variety of complementary therapies were also trialed (Table 1). Other steps to improve health included stress management, exercise, reduced alcohol/drug intake, yoga, meditation and counselling.Many people reported n o change in circumstance due to their infection. Others reported negative effects on physical and mental health, and social interaction ( Table 2). Reports of isolation and discrimination related to community concern about HCV, stereotyping of people with H C V and adverse media portrayal of the disease. Respondents had concerns about commencing relationships, HCV infection having ended relationships, introduced fear and/or tension, a...

Quality of life in HCV‐infection: lack of association with ALT levels

“…It would seem that nearly all of the individuals taking part in the stage 2 interviews were distressed by the perceived stigma associated with HCV infection, whether this was related to societal fear of contagions or to the association of HCV and IV drug use. Consistent with Sladden et al, 26 most related stories of actual or feared social loss, or described withdrawal of support from family and friends. In the quantitative analysis, those with lower satisfaction with social support (per SSQ6 satisfaction quotient) were also found to have significantly lower mental health scores.…”

“…Based on the few studies of the social aspects of this disease, however, HCV-status may be perceived by those affected as a substantial barrier to commencing and maintaining relationships and may also have other far-reaching social effects. [26][27][28] Variables such as age at infection, time since infection, and ethnicity are thought to have an influence on HCV progression, 20,22,[29][30] however their influence on reported morbidity in HCV has not been investigated.…”

Impact of hepatitis C virus infection on lifestyle

“…All international guidelines recommend that patients with hepatitis C virus infection or other chronic liver disease consume no alcohol [3][4][5][6][7][8] . Our data, in line with pervious studies, indicate that most patients with chronic HCV infection do modify their alcohol intake following diagnosis [12][13][14] . Possible hepatotoxicity of tobacco has been suggested only recently.…”

“…There are few data available regarding how many patients with hepatitis C infection change their lifestyle, adopting healthy behaviours and/or unnecessar y restrictions [12][13][14] . This information is necessary to plan educational programmes and to improve counselling given to chronic hepatitis C patients.…”

Living with hepatitis C: A sociological review

“…The authors conclude that the present testing situation in Australia is not a means by which to promote behaviour change. Sladden et al (1998) highlight the diverse consequences and responses people have to hepatitis C infection. In this study many people reported no change in their life since a positive diagnosis while others reported a significant deterioration in circumstances and well-being.…”