Assessment of health-related quality of life in adult chronic hepatitis C patients with different categories of disease and sustained response to Intron(rtm) A

A study was conducted to evaluate health-related quality of life (HQL) of chronic hepatitis C (CHC) patients with various stages of disease using a validated questionnaire (SF-36 plus additional generic scales, disease-specific module, symptom inventory, health utilities). Secondary objectives were correlations between HQL and viremia; genotype; absence or presence of fibrosis/cirrhosis; and physical findings. 132 patients had mild hepatic necroinflammation, 113 had moderate, 28 had severe, 81 had decompensated cirrhosis and 27 were INTRON{dollar}spcircler{dollar} A (IFN) responders. A questionnaire was administered then blood was collected for hematology, blood chemistries, and HCV virus studies. There were no differences in HQL based on severity of necroinflammation; patients were classified as non-fibrosis/cirrhosis or fibrosis/cirrhosis. IFN non-fibrosis/cirrhosis patients had best SF-36 scores and decompensated patients had worst scores. No significant difference was seen in HQL between IFN non-fibrosis/cirrhosis patients and the general population (p = 0.50). Significantly lower HQL was seen in all other groups (p {dollar}le{dollar} 0.002). Mean scores for additional scales and the disease-specific module showed significant differences among groups for all measures (p {dollar}le{dollar} 0.001). Ninety-six percent reported one or more symptoms; 73% reported symptoms that were problematic or interfered with daily activities. The most frequent symptom was fatigue (25% of IFN non-fibrosis/cirrhosis patients, 40-80% of other groups). Health utilities generally lacked sufficient sensitivity to describe HQL in CHC patients. Mean SF-36 scores for non-fibrosis/cirrhosis patients were fairly consistent for most domains regardless of the level of viremia. No relationship was seen between HQL and genotype. The following conclusions are supported by the results of this study: untreated CHC is associated with considerable decrement in HQL; patients without fibrosis or cirrhosis who respond to INTRON{dollar}spcircler{dollar} A have HQL similar to the general population; once progression to fibrosis or cirrhosis occurs, HQL is improved little by intervention; patients with decompensated disease have the worst HQL by all measures; patients should receive treatment before permanent damage is done to the liver.