The impact of chronic hepatitis C and co-morbid illnesses on health-related quality of life
Division of Gastroenterology and Hepatology, Department of Medicine, VA Palo Alto Health Care System, (154C), 3801 Miranda Avenue, Palo Alto, CA 94304, USA. Quality of Life Research
(Impact Factor: 2.49).
06/2008; 17(5):715-24. DOI: 10.1007/s11136-008-9344-3
Determine the relative impact of chronic hepatitis C (CHC) and co-morbid illnesses on health-related quality of life (HRQoL) in 3023 randomly selected veterans with known hepatitis C virus antibody (anti-HCV) status who previously completed a veteran-specific HRQoL questionnaire (SF-36V).
Multiple regression analyses were performed to measure the relative contribution of anti-HCV status, four demographic variables, and ten common medical and six psychiatric co-morbidities to HRQoL between 303 anti-HCV(+) and 2720 anti-HCV(-) patients.
Anti-HCV(+) veterans were younger, reported a lower HRQoL on seven of eight 36-Item Short Form Health Survey for Veterans (SF-36V) subscales (P < or = 0.001) and the mental component summary (MCS) scale (P < 0.001). The ten medical and six psychiatric co-morbidities had variable impact on predicting lower HRQoL in both groups. After adjusting for demographic variables and co-morbid illnesses, we found that anti-HCV(+) patients reported a significantly lower MCS score (P < 0.001) and a trend toward a lower physical component summary (PCS) score (P < 0.07) compared to anti-HCV(-) veterans. Among the anti-HCV(+) veterans, co-morbid medical illnesses contributed to impaired PCS but not to MCS.
Veterans with CHC were younger than HCV(-) veterans and hence less likely to have other co-morbid medical illnesses. Medical co-morbidities seen in those veterans with CHC contribute to impaired PCS but not MCS. Anti-HCV(+) status negatively affects HRQoL, particularly MCS, independently of medical and psychiatric co-morbidities.
Available from: Sheng-Shun Yang
- "Studies of HRQOL of CHC patients undergoing treatment have shown that antiviral treatment has an enormous impact on HRQOL compared with untreated patients
[15-20]. Reports indicate that the HRQOL of untreated CHC patients either resembles the general population
 or is lower than that of healthy individuals
[20,22,23]. Two previous studies addressed the HRQOL in CHC patients undergoing treatment in countries with a high HCV prevalence such as Taiwan. "
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Interferon (IFN) therapy can cause significant side effects in chronic hepatitis C (CHC) patients; however, the health-related quality of life (HRQOL) of antiviral-treated CHC patients has not been established in Taiwan. This study evaluated domains and the degree to which antiviral treatment affects the HRQOL in CHC patients and identifies factors associated with variations between patients.
Health-related quality of life (HRQOL) was assessed using the Short Form-36 (SF-36) and the Chronic Liver Disease Questionnaire (CLDQ) in 108 antiviral-treated CHC patients. Eight scales and two summary scales of the SF-36 were compared with 256 age- and gender-matched population norms and 64 age- and gender-matched CHC patients without antiviral therapy. Descriptive statistic measures, one-way ANOVA, and regression analysis were used for data analysis.
(1) CHC patients receiving antiviral treatment displayed significantly lower scores in six scales, the Physical Component Summary (PCS), and the Mental Component Summary (MCS) of the SF-36, when compared to the population norms and patients without antiviral therapy (p < 0.05). (2) The mean CLDQ score of antiviral-treated patients was lower than that of patients without antiviral therapy, including subscales of ‘fatigue’, ‘systemic symptoms’, and ‘role emotion’. (3) All SF-36 subscales significantly correlated with all CLDQ subscales, with the greatest correlation coefficients shown between fatigue and vitality and mental health of SF-36. (4) Antiviral therapy had a greater negative impact on females in the CLDQ, on all patients during treatment weeks 9–16 in the PCS and on patients with a monthly income of less than NT$10,000 in the CLDQ, PCS, and MCS.
This study highlighted impairments in the quality of life of chronic hepatitis C patients treated with IFN-based therapy. The significant factors associated with HRQOL include gender, income, and treatment duration. The results of this study might provide nurses with a comprehensive understanding of HRQOL and its determining factors in antiviral-treated CHC patients. The findings can serve as a useful reference for nursing personnel in developing instructions for upgrading the care of CHC patients.
Available from: Jason Dominitz
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ABSTRACT: Little is known about differences among hepatitis C virus (HCV) patients managed by generalists vs. specialists with respect to patient-centred outcomes, such as disease-specific knowledge, health-related quality of life (HRQoL) and satisfaction with care.
To examine selected patient-centred outcomes of HCV-related care provided in primary care, specialty care or both.
A total of 629 chronic HCV patients completed a survey including an HCV knowledge assessment and validated instruments for satisfaction and HRQoL. Multivariable linear regression was used to compare outcomes between groups.
Adjusted total HCV knowledge score was lower among patients who did not attend specialty care (P < 0.01). Primary care and specialty patients did not differ in adjusted general HRQoL or satisfaction. Sixty percent of specialty patients underwent formal HCV education, which was associated with 5% higher knowledge score (P = 0.01). General HRQoL and patient satisfaction did not differ between primary care and specialty groups. Disease-specific knowledge and care satisfaction were independent of mental illness, substance abuse, socio-economic variables, history of antiviral treatment, formal HCV education and duration of time between last visit and survey completion.
Primary care patients with chronic HCV have lower adjusted disease-specific knowledge than specialty patients, but no difference in general HRQoL or patient satisfaction.
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ABSTRACT: Hepatitis C virus (HCV) infection impairs quality of life (QOL) in patients who are not on dialysis therapy. In dialysis patients, how HCV infection affects QOL is unknown. In our study, we investigated the independent relationship between HCV infection and QOL.
Sociodemographic and laboratory variables were recorded. Severity of depressive symptoms and QOL were assessed by Beck Depression Inventory (BDI) and Short Form-36 (SF-36), respectively.
Among 165 patients, 83 were anti-HCV antibody positive and 82 were anti-HCV antibody negative. Anti-HCV antibody positive patients had higher BDI scores than anti-HCV antibody negative patients (P = 0.011). Other than the social functioning subscale, all SF-36 subscales were lower in anti-HCV antibody positive patients when compared with anti-HCV negative patients. Anti-HCV antibody positive patients had lower physical (P = 0.003) and mental component summary scores (P = 0.018) than negative patients. Physical component summary score was independently associated with hemodialysis duration (P = 0.003), sleep disturbance (P = 0.046), BDI score (P = 0.027), albumin (P = 0.002), and serum hemoglobin (P < 0.0001). Physical component summary score was not associated with anti-HCV antibody positivity. Mental component summary score was independently associated with BDI score (P = 0.001), anti-HCV antibody positivity (P = 0.016), and serum hemoglobin (P < 0.0001).
HCV infection impairs QOL, especially in mental aspects, in hemodialysis patients.
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