Impact of chronic HCV treatment on quality of life of patients with metabolic disorders in context of immunological disturbances

Abstract

Chronic viral hepatitis C (CHC) and its complications have a negative effect on patient's quality of life. We evaluated the impact of a successful interferon-free treatment on the quality of life of patients with obesity and metabolic disorders in the context of immunological disturbances. Twenty overweight or obese (BMI > 25) patients with CHC were tested before the therapy and after a successful treatment regimen. After the therapy, patient's emotional well-being improved (p = 0.02), while physical well-being remained unchanged. There was a decrease of patient's liver fibrosis and an increase of steatosis along with body mass. Among HCV-infected individuals, the expression of toll-like receptor 3 (TLR3) on lymphocytes was higher than in the control group (p = 0.03), but it decreased (p = 0.001) after the treatment. There was also a decrease of the intensity of immunofluorescence of FoxP3+ after the treatment (p = 0.04). Our study showed an improvement in mental aspects of patient's quality of life after the treatment. Unfortunately, probably due to rapid immunological changes, patient's BMI, serum cholesterol levels and hepatic steatosis have a tendency to increase and may lead to cardiovascular and other complications, like hepatocellular carcinoma.

Figure 1

Results of the RAND SF-36 questionnaire before (T0, first bar) and after (T2, second bar) the treatment. There was a significant (Wilcoxon signed-rank test, p < 0.05) change in emotional role functioning, vitality, general health perceptions and perceived health change. The result called “mental health” did not differ significantly before and after the treatment. However, since we observed substantial improvement in other categories of the SF-36 survey, that are used to describe mental aspects of health as well (emotional role functioning and vitality) visible improvement in social role functioning, we still conclude that the overall mental health improved after the treatment.

Figure 2

Liver steatosis before and after the treatment. CAP measured with FibroScan increased from 253 before the treatment (T0) up to 287 after a successful treatment (T2) and the change was statistically significant (Wilcoxon signed-rank test, p < 0.05).

Figure 3

Spearman’s correlations between initial levels of various cholesterol fractions and the change of hepatic steatosis level after the treatment. (A) – positive correlation with initial triglycerides (TAG) (r = 0.57, p < 0.05); (B) – negative correlation with HDL levels (r = −0.45, p < 0.05); (C) - positive correlation with LDL fraction (r = 0.47, p < 0.05); D – positive correlation of steatosis change with pre-treatment total serum cholesterol (r = 0.47, p < 0.05).

Figure 4

BMI before (T0) and after (T1 and T2) the treatment. The increase from 28.5 at T0 up to 30.9 at T2 was statistically significant (Wilcoxon signed-rank test, p < 0.05).

Figure 5

TLR3 expression level on T lymphocytes based on the mean fluorescence intensity; median levels before (T0) and after the treatment (T1) compared with the control group. All presented measurements differ significantly (Mann-Whitney U test and Wilcoxon signed-rank test, p < 0.05).

Figure 6

Percentage of T lymphocytes with TLR3 expression before (T0) and after (T1) the treatment. The presented measurements differ significantly (Wilcoxon signed-rank test, p < 0.05).

Figure 7

Percentage of leukocytes with FoxP3 expression among HCV-infected patients (T0) and healthy controls. The presented measurements differ significantly (Mann-Whitney U test, p < 0.05).

Figure 8

Correlation between the change in total cholesterol levels and the change in leukocytes with FoxP3 expression before and after the treatment. Spearman’s rank correlation coefficient r = −0.68, p < 0.05.