The effects of HCV infection and management on health-related quality of life.
Infection with HCV leads to an array of symptoms that compromise health-related quality of life (HRQL). Chronic hepatitis C is treated primarily with pegylated interferon (peg-IFN) and an inosine 5' monophosphate dehydrogenase inhibitor, ribavirin (RBV), with the goal of achieving a sustained virologic response (SVR). SVR reduces the rate of hepatic fibrosis and other disease-related complications and, in turn, increases HRQL. Although combination therapy with peg-IFN and RBV produces SVRs in more than 50% of treated patients, it is associated with side effects that can reduce short-term HRQL, can lead to dose reductions and discontinuations, and may impair treatment response. Fatigue and depression are common symptoms of chronic HCV infection that may also be caused by IFN-based therapy. Hemolytic anemia and IFN-mediated bone marrow suppression are well-known consequences of IFN/RBV therapy, often resulting in dose reductions or discontinuations, and have the potential to affect SVR rates. Management of these symptoms is vital to successful outcomes and generally relies on therapy that is adjunctive to the primary treatment of the viral infection itself. Several new drugs with the potential to increase SVR rates without compromising HRQL are in development.


CONCLUSIONS
The relationship of chronic HCV infection, treatment, and HRQL is complex. Successful treatment of chronic hepatitis C requires an understanding of the intricacies of this relationship and appropriate management of treatment-related symptoms.
Younossi
Zobair
Z
Center for Liver Diseases, Inova Fairfax Hospital, Inova Outcomes Research Program, Inova Health System, Falls Church, VA, Annandale, VA 22003, USA. zobair.younossi@inova.com
Kallman
Jillian
J
Kincaid
John
J
D000998:Antiviral Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D003863:Depression / Q000139:chemically induced; D005221:Fatigue / Q000139:chemically induced; D006304:Health Status; D016174:Hepacivirus; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use; D008107:Liver Diseases / Q000188:drug therapy / Q000523:psychology / Q000821:virology; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000627:therapeutic use; D011788:Quality of Life / Q000523:psychology*; D011994:Recombinant Proteins; D012254:Ribavirin / Q000009:adverse effects / Q000627:therapeutic use
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a