title: Impact of treatment on extra hepatic manifestations in patients with chronic hepatitis C.
abstract: OBJECTIVE
  Fatigue and other extra hepatic manifestations of hepatitis C have never been studied prospectively in a large cohort. The aim was to assess the prevalence of these symptoms prior to any treatment, and on prolonged follow-up in treated and untreated patients.
  
  
  METHODS
  A single-center cohort of consecutive patients with chronic hepatitis C was investigated prior to any treatment. A questionnaire was completed every 6 months for 18 months of follow-up.
  
  
  RESULTS
  Of 1614 patients, 431 met the inclusion criteria (56% male; age 49 years; 60% with significant fibrosis or cirrhosis; 46% with cryoglobulinemia). Seventy-six were untreated; of the treated patients, 83 were sustained responders, 47 relapsers and 225 non-responders. At baseline, fatigue and other extrahepatic manifestations were present in 254 (59%) and 225 (52%) patients. Fatigue was improved in 29 of 83 (35%) responders versus 75 of 348 (22%) patients with detectable hepatitis C virus (HCV)-RNA (P=0.01). The impact of virologic response on fatigue persisted after adjusting for age, gender, fibrosis stage, and depression (odds ratio: 0.34, P<0.001). A cryoglobulin was detectable in two of 34 (6%) responders versus 38 of 115 (33%) patients with detectable HCV-RNA (P<0.001).
  
  
  CONCLUSIONS
  In hepatitis C, a sustained virologic response is associated with a reduction in fatigue and cryoglobulin, but fatigue frequently persists despite a virologic response.
authors.affiliation: Department of Internal Medicine, Hôpital La Pitié-Salpêtrière, 83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France. patrice.cacoub@psl.ap-hop-paris.fr
authors.forename: Patrice
authors.initials: P
authors.lastname: Cacoub
authors.forename: Vlad
authors.initials: V
authors.lastname: Ratziu
authors.forename: Robert P
authors.initials: RP
authors.lastname: Myers
authors.forename: Pascale
authors.initials: P
authors.lastname: Ghillani
authors.forename: Jean Charles
authors.initials: JC
authors.lastname: Piette
authors.forename: Joseph
authors.initials: J
authors.lastname: Moussalli
authors.forename: Thierry
authors.initials: T
authors.lastname: Poynard
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage*; D018771:Arthralgia / Q000209:etiology; D015331:Cohort Studies; D003449:Cryoglobulinemia / Q000209:etiology; D003863:Depression / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011795:Surveys and Questionnaires
chemical_list: D000998:Antiviral Agents