The impact of diagnosis of hepatitis C virus on quality of life

Abstract

Many patients with chronic hepatitis C virus (HCV) infection report disabling fatigue and a reduced sense of well-being. Scores on quality of life (QOL) scales, such as the Sickness Impact Profile or the Short Form 36 (SF-36) scale, have been reported as significantly worse for patients with HCV than for healthy controls. 1-3 These studies could not, however, determine the impact of HCV diagnosis per se on QOL because all patients were aware of their diagnosis at the time of completion of the QOL scales. A recent editorial in HEPATOLOGY highlighted the question of whether subjective health perceptions are influenced by diagnosis with HCV. 4 This study reports the impact of diagnosis of HCV on QOL. We report here QOL scores of a group of patients with long-standing HCV infection, only approximately half of whom were aware that they were HCV seropositive at the time the QOL scores were measured. To investigate the impact of HCV diagnosis on QOL, we compared the scores between those aware of their serostatus and those not aware. PATIENTS AND METHODSThis study is part of a retrospective cohort study investigating the natural history of chronic HCV infection by following up all persons admitted to Fairfield Infectious Diseases Hospital in Melbourne, Australia, who had a clinical and biochemical diagnosis of acute viral hepatitis between 1971 and 1975 and on whom stored frozen sera from that time were available.Stored serum of 238 patients was strongly reactive for antibody to HCV (anti-HCV). Follow-up methods were systematically applied to locate cohort members; these included searches of death registers, electoral rolls, telephone directories, and contact with next-of-kin. By late 1998, 97 (41%) had been located and recruited into the study. Subjects were told at the time of recruitment that the study was looking at the outcome of hepatitis infection in patients who had been admitted to hospital with hepatitis 25 years ago. Health outcomes in subjects were then assessed by a studyspecific questionnaire, clinical examination, repeat serology, virology, and liver function tests using standardized proformas to record results. As well, all subjects completed the SF-36 scale, a generic and widely used QOL instrument, which has been adapted for use in Australia.5 Once all study results were obtained, the process of imparting the diagnosis of chronic HCV infection (to those unaware of serostatus) and the fact that blood had been taken at the time of original admission (in the early 1970s) and tested as part of this study for anti-HCV was commenced. In this way, patients who were unaware of their anti-HCV status at the time of recruitment completed all parts of the study, including the SF-36 questionnaire, without this knowledge. This approach was taken partly to assess the impact of knowledge of HCV diagnosis on QOL and also to obtain current anti-HCV status, HCV polymerase chain reaction (PCR) results, and liver function test results to allow appropriate counseling as to current health status, degree of infectivity, and l...

The effects of HCV infection and management on health-related quality of life

“…Fatigue is generally the most frequently reported extrahepatic symptom in patients with CHC, although some researchers suggest that this fatigue is more closely related to depression severity than to hepatic disease itself. 6,8,15,33,35,36,49 Fatigue is reported to affect response to IFN-based therapy. 35 Maddock et al 64 used four self-report questionnaires to monitor side effects and HRQL in 29 patients with CHC and reported that patients experiencing severe fatigue were less likely to respond to therapy.…”

“…Fatigue was reported in 53% of patients and was disabling in 17%, 35 findings consistent with those of other studies in which the prevalence ranged from 50% to 67%. 6,8,15,33,35,36 Fatigue was also independently associated with age and female sex. Fatigue was not associated with viral factors.…”

“…A diagnosis of HCV infection alone can affect patient quality of life. In a retrospective cohort study of 34 patients with CHC, Rodger et al 36 found that patients who were aware of their serostatus before consultation scored significantly worse on 7 of 8 domains of the SF-36 than those who were unaware of their serostatus. The authors concluded that the difference in the HRQL impairment between the 2 groups was in part a result of "labeling," by which a diagnosis of a chronic disease could produce a psychological disturbance.…”

“…The authors concluded that the difference in the HRQL impairment between the 2 groups was in part a result of "labeling," by which a diagnosis of a chronic disease could produce a psychological disturbance. 36 The stigmatization of HCV infection can affect HRQL (Fig. 1).…”

“…1). 36,[47][48][49] Zickmund et al 50 examined the hypothesis that patients with CHC experience stigmatization that negatively affects HRQL is independent of mode of HCV acquisition. Study patients completed several assessment tools, including the Sickness Impact Profile and the Hospital Index Depression Scale, and took part in semistructured interviews.…”