Abstract
BackgroundDirect-acting antivirals (DAA) have demonstrated high efficacy to achieve sustained virological response (SVR) in chronic hepatitis C patients. We aim to assess the change in health-related quality of life (HRQoL) among patients successfully treated, and to identify predictors of this variation.MethodsIn a prospective observational study, patients with chronic hepatitis C who started DAA therapy between May 2016 and April 2017 completed the EQ-5D-5L questionnaire at baseline and 12 weeks after the end of therapy before knowing the virological result. Analysis included all patients with SVR.ResultsMedian baseline EQ-5D-5L scores of the 206 enrolled patients were 0.857 utility and 70.0 visual analogue scale (VAS). Following SVR, a reduction occurred in the proportion of patients with mobility problems (35% vs 24%, p = 0.012), pain/discomfort (60% vs 42%, p<0.001) and anxiety/depression (57% vs 44%, p = 0.012), with an increase in utility (+0.053, p<0.001) and VAS (+10, p<0.001). Score improvements were also observed in cirrhotic (+0.048 utility, p = 0.027; +15 VAS, p<0.001) and HIV co-infected patients (+0.039 utility, p = 0.036; +5 VAS, p = 0.002). In multivariate analyses, middle age (45–64 years) and baseline anxiety/depression were associated to greater improvement in utility after SVR, and moderate-advanced liver fibrosis and cirrhosis to greater increase in VAS score. Low baseline values were associated to greater improvements in utility value and VAS score.ConclusionsThe cure of chronic hepatitis C infection with DAA has a short term positive impact on HRQoL with improvement in mobility, pain/discomfort, anxiety/depression, utility value and VAS score. Patients with poor baseline HRQoL were the most beneficed.
Highlights
Chronic hepatitis C constitutes a well-recognize global public health issue, mainly due to its worldwide high prevalence and the serious consequences of progression of disease
Middle age (45–64 years) and baseline anxiety/depression were associated to greater improvement in utility after sustained virological response (SVR), and moderate-advanced liver fibrosis and cirrhosis to greater increase in visual analogue scale (VAS) score
Eight patients were excluded from the final analysis, 4 due to loss during the follow-up and another 4 due to not achieving SVR, leaving 206 patients cured of chronic Hepatitis C virus (HCV) infection
Summary
Chronic hepatitis C constitutes a well-recognize global public health issue, mainly due to its worldwide high prevalence and the serious consequences of progression of disease. Hepatitis C virus (HCV) leads to cirrhosis in up to 20% of those chronically infected [1] and of these, 2–4% annually develop hepatocellular carcinoma [2]. Chronic HCV infection is the primary indication for liver transplantation in developed countries [3]. The economic burden is multiplied by the impact of HCV on health related quality of life (HRQoL), appreciable at any stage of severity [4,5]. We aim to assess the change in healthrelated quality of life (HRQoL) among patients successfully treated, and to identify predictors of this variation
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