Hepatitis C can have a very negative effect on a person's health-related quality of life, but success with HCV treatment can ease this negative effect, says a new study.¹

The research also suggests that traditional measures of liver disease in people with hepatitis C, such as liver histology (measure of the health of the liver) and levels of an enzyme known as alanine aminotransferase (ALT) that can indicate liver damage do not necessarily correspond to differences in a person's health-related quality of life.

The study was conducted by a team of gastroenterologists in the VA Greater Los Angeles Healthcare System and at UCLA.

Quality of Life Considerations Lacking?
The impact of HCV on a person's health-related quality of life is "dramatic", wrote Brennan Spiegel, MD, Fasiha Kanwal, MD, and their colleagues, "resulting from complications of advanced liver disease such as encephalopathy, variceal hemorrhage, ascites, and liver transplantation." Nonetheless, the vast majority of people with HCV have no clinically significant liver disease, but still experience a diminished quality of life," they added. Some of the reasons for this may include certain relative symptoms that occur outside of the liver like cognitive dysfunction related to the hepatitis infection, or "comorbid psychosocial disorders."

While more and more medical researchers have been focusing on the significance of measuring a patient's quality of life, "most clinicians are not versed in the interpretation of health-related quality of life in HCV, and patient-oriented outcomes such as health-related quality of life may fail to resonate with clinicians in the same way as traditional biological parameters," Spiegel and his team pointed out.

By better understanding the impact of HCV infection on a person's quality of life, the entire health burden of hepatitis C can be better understood, they said.

"We hope that this information can percolate down to clinicians, who in turn might use this information in their everyday clinical practice," said Kanwal, a research fellow in the division of Digestive Diseases at UCLA, in an e-mail interview with Priority Healthcare. For example, patients could fill out a quality-of-life questionnaire in the waiting room and the responses could be added to their chart, he said. "The next time they present, the same questionnaire could be administered. This would provide the physician with information about how their health-related quality of life changed over time, a key measurement to determine whether therapy is working."

But he added that one study will not likely create significant change, and so the best approach might be a series of educational programs that highlight the significance of health-related quality of life for people with hepatitis.

Data Ascertained
To better clarify the effect that HCV has on quality of life, the investigators conducted a metaanalysis—a review of a series of studies, and focused on five key objectives:

• Identify studies pertaining to health-related quality of life in people with HCV.
• Compare the quality of life reported by those with HCV versus those without the infection.
• Compare the health-related quality of life reported by people who have achieved a sustained virologic response (SVR) to hepatitis C therapy compared to those who did not achieve an SVR.
• To categorize health-related quality of life in people with HCV by liver disease severity, as well as neurological, psychological, and social factors.
• To establish the minimally clinically significant difference in health-related quality of life in people with hepatitis C infection.

The investigators analyzed 32 studies published between 1990 and 2004. About half of them compared health-related quality of life between those with HCV and those who were not infected. The results suggested that people with hepatitis C had a diminished quality of life, most dramatically in social and physical function, general health, and vitality.

Nine studies defined health-related quality of life as a response to treatment. They indicated that quality of life is consistently worse in those who fail to achieve an SVR to treatment.

An additional six studies examined health-related quality of life by its psychological effects and found that HCV had a negative impact in terms of cognitive dysfunction, depression, emotional distress, and stigmatization.

The remaining research defined health-related quality of life in relation to a person's liver function. The results showed that patients did not perceive subtle biochemical or liver function changes as clinically important, but large differences in quality of life were noted in people with cirrhosis, nevertheless.

A Fusion of Factors to Consider
"In conclusion, chronic HCV diminishes health-related quality of life across a wide range of clinical anchors. The impact on health-related quality of life is highly clinically significant and affects physical, social, and mental health domains," the study team wrote.

Thus, eradicating the virus "may improve health-related quality of life," said Kanwal. "Taken together, these facts suggest that patients with subclinical HCV may benefit from treatment, not only to eradicate the virus, but also to improve their overall health status."

The clinical impact of this awareness might be that more people wind up being treated earlier, he said.

1. Spiegel BM, Younossi ZM, Hays RD, Revicki D, Robbins S, Kanwal F. Impact of hepatitis C on health related quality of life: A systematic review and quantitative assessment. Hepatology 2005 Mar 24;41(4):790-800. [Epub ahead of print].

John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.