Health-related quality of life in patients with chronic hepatitis C and advanced fibrosis

Abstract

Background/aims: Although the antiviral and histological benefits of peginterferon/ribavirin therapy are well established, the effects on health-related quality of life (HRQOL) and sexual health are less certain. This study assessed HRQOL and sexual health in patients with advanced fibrosis or cirrhosis in the HALT-C Trial.

Methods: Subjects completed SF-36 and sexual health questionnaires prior to and after 24 weeks of peginterferon/ribavirin therapy (n=1144). Three hundred and seventy-three (33%) subjects were HCV RNA negative at week 20 and continued therapy through week 48; 258 were seen at week 72. One hundred and eighty achieved sustained virological responses (SVR) and 78 relapsed.

Results: At baseline, patients had poorer scores for all eight SF-36 domains compared to healthy controls. Patients with cirrhosis had lower HRQOL scores than those with bridging fibrosis, as did patients with higher depression scores. SVR patients had significant improvements in seven domains, whereas relapsers had significant worsening in one domain. Sexual scores improved in SVR patients and decreased in relapsers (p=0.03). In multivariate analyses, improvements in HRQOL and sexual scores were significantly associated with SVR but were less striking in patients with lower depression scores.

Conclusions: Achievement of SVR after peginterferon/ribavirin therapy improves HRQOL and sexual health in chronic hepatitis C patients with advanced fibrosis or cirrhosis.

Fig. 1

Overview of HALT-C Trial: HRQOL assessments at baseline and week 72.

Fig. 2

HRQOL scores at baseline of the eight scales of the SF-36 Health Survey (n = 1144). Higher scores indicate better HRQOL. Abbreviations: BP, bodily pain; GH, general health; MH, mental health; PF, physical functioning; pts., patients; RE, role emotional; RP, role physical; SF, social functioning; VT, vitality.

Fig. 3

Change from baseline to week 72 in SF-36 scores by virologic response status (n = 254). Positive values indicate improvements; negative values indicate worsening. Abbreviations are as in the legend to Fig. 2. (SVRs, sustained virological responders.)

Fig. 4

Change from baseline to week 72 in HRQOL summary scales by virologic response status (n = 254). Positive values indicate improvements; negative values indicate worsening. (SVRs, sustained virological responders.)