title: Short article: Fatigue in the long term after HCV treatment in HIV-HCV-coinfected patients: functional limitations persist despite viral clearance in patients exposed to peg-interferon/ribavirin-containing regimens (ANRS CO13-HEPAVIH cohort).
abstract: OBJECTIVE
  To analyze the impact of fatigue on individuals' global, cognitive, physical, and psychosocial functioning in the long term after hepatitis C virus (HCV) treatment and its relationship with HCV clearance among patients coinfected with HIV and HCV exposed to peg-interferon/ribavirin-containing regimens.
  
  
  METHODS
  The study sample included 107 coinfected patients treated for HCV during follow-up in the French ANRS CO13-HEPAVIH cohort. Analyses used scores from the Fatigue Impact Scale (FIS), assessed before treatment initiation and at last available measure after the end of treatment (2 years in median). Patient proportions with a clinically significant improvement in fatigue impact, defined as a decrease higher than 10 points in the 160-point global FIS score, were compared between HCV clearers and chronic HCV patients (Fisher's exact test). Relationships between HCV clearance and FIS scores were analyzed in linear regression models adjusted for sex, time since end of HCV treatment, and pretreatment scores.
  
  
  RESULTS
  Twenty-nine percent of patients showed a clinically significant improvement in fatigue (15/57 in HCV clearers vs. 16/50 in chronic HCV patients, P=0.52). HCV clearance was not significantly associated with FIS scores in multivariate models.
  
  
  CONCLUSIONS
  The role of HCV clearance in coinfected patients' functional recovery in the long term after peg-interferon/ribavirin treatment may be lesser than expected. Additional studies are needed in patients treated with direct-acting antiviral agents. In the meantime, the effectiveness of palliative care and targeted psychological treatments such as cognitive-behavioral therapy in reducing fatigue impact needs to be assessed in the many HCV-cured patients with HIV exposed to suboptimal interferon-based first-generation therapies.
authors.affiliation: aINSERM, UMR_S 912, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale (SESSTIM), F-13385, Marseille, France bAix Marseille Université, UMR_S 912, IRD, Marseille, F-13385, Marseille, France cORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, F-13006, Marseille, France dAix-Marseille Université, Assistance Publique - Hôpitaux de Marseille Sainte-Marguerite, Service d'Immunohématologie Clinique, Marseille, France eService des Maladies Infectieuses et Tropicales, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France fUniversité Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, F-33000 Bordeaux, France gINSERM, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, F-33000 Bordeaux, France hService des Maladies Infectieuses et Tropicales, Hôpital Cochin, AP-HP, Paris, France iUniversité Paris Descartes, Paris, France.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Marcellin
authors.forename: Camelia
authors.initials: C
authors.lastname: Protopopescu
authors.forename: Isabelle
authors.initials: I
authors.lastname: Poizot-Martin
authors.forename: Patrick
authors.initials: P
authors.lastname: Miailhes
authors.forename: Laure
authors.initials: L
authors.lastname: Esterle
authors.forename: Linda
authors.initials: L
authors.lastname: Wittkop
authors.forename: Bruno
authors.initials: B
authors.lastname: Spire
authors.forename: Aurélie
authors.initials: A
authors.lastname: Bocquier
authors.forename: Dominique
authors.initials: D
authors.lastname: Salmon-Ceron
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.forename: Maria Patrizia
authors.initials: MP
authors.lastname: Carrieri
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D060085:Coinfection; D004359:Drug Therapy, Combination; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005602:France; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000009:adverse effects / Q000627:therapeutic use*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020127:Recovery of Function; D012254:Ribavirin / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons