Tag Archives: Quality of Life

Snapshots, by Alan Franciscus, Editor-in-Chief

Posted on by December 13, 2015
Article: Depression rather than liver impairment reduces quality of life in patients with hepatitis C—LD Silva, et al
  Source: Rev Bras Psiquiatr. 2015 Jan-Mar;37(1):21-30. doi: 10.1590/1516-4446-2014-1446
 
Results and Conclusion: In the current study there were 124 patients (72 females; 52 males; mean age 53 yo).  The patients were given various clinical and psychiatric evaluations.  No patients were receiving HCV treatment.  Various in-person interviews were given to determine socio-economic information, health-related quality of life, income, smoking, alcohol and drug use. 
The study results found that 30.6% had major depressive disorder, which is consistent with other studies. The degree of major depressive disorder and other psychiatric disorders found in people with hepatitis C is associated with health-related quality of life rather than tied to the degree of liver fibrosis.  The authors noted that more attention needs to be devoted to “the implementation of integrated medical, psychiatric, and [that] psychological care may be helpful.”
 
The Bottom Line: Up to 70% of people with chronic hepatitis C have depressive disorders—this is a seven-fold higher rate than the general population.
 
Editorial Comment: Does HCV cause depression?  Many experts believe that the hepatitis C virus causes depression, but the exact mechanism hasn’t been completely understood.  There have been some studies that have shown that the hepatitis C virus passes the blood-brain barrier and there have been viral particles found in brain tissue.  Another possible reason for depressive disorders could potentially be the results of the immune system cells fighting off the virus in brain tissue.   
Regardless of what causes depression in people with hepatitis C, it is clear that curing hepatitis C also can increase the quality of life leading to a wide variety of improvements in health including mental health. It’s time that we recognize that we should treat everyone with hepatitis C regardless of the degree of liver damage—hepatitis C is NOT just a liver disease.
 
Article: Changes in characteristics of hepatitis C patients seen in a liver center in the United States during the last decade—N Talaat et al.
  Source: Journal of Viral Hepatitis Volume 22,Issue 5, pages 481–488, May 2015
 
Results and Conclusion: This was a retrospective study of the records of patients seen in liver clinics 1998-1999 (Era-1) compared to the records of patients seen 2011-2012 (Era-2)
The current study sought to describe the characteristics of people with HCV who were newly referred to liver clinics in Era-1 (538 patients). The records from Era-1 patients were compared to those of patients who were seen in Era-2 (810 patients).  Advanced liver disease was defined as cirrhosis, decompensated cirrhosis, or liver cancer.  
The patients in Era-2 were older (median age 56 vs 45 years), more likely to be Black (17.2% vs 11.6%) and had a longer interval between diagnosis and referral (median 4 years vs 2 years).  Genotype 1 was similar in both Era’s, but genotype 1a was 39.9% vs 53.8% in Era-2.  
Even though there was a higher percentage of treatment-experienced patients in the Era 2 patient group, the comparison showed that more than three quarters of the patients had never been treated.    
Era-2 patients were more likely to have advanced disease at referral (61.6% vs 51.5%)—with an   eightfold higher prevalence of HCC or liver cancer (21.6% vs 2.6%).
 
The Bottom Line:  The changes in the Era-2 patients points to important trends in the hepatitis C population.  These changes occurred over a relatively short period of time:   
  • The majority of patients identified had not been treated.
  • More patients had HCV genotype 1a – generally a more difficult genotype/subtype to treat.  This also reflects a change in the demographics of the HCV population of the United States.
  • The aging of the HCV population is reflective of more advanced disease including an eight-fold increase in liver cancer.

Editorial Comment:  This study speaks volumes.  In this short period of time there has been a major advance in the rate of liver disease progression—most notably the increase in liver cancer is frightening.  

http://hcvadvocate.org/news/newsLetter/2015/advocate0515.html#4

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Snapshots, by Alan Franciscus, Editor-in-Chief

Posted on by December 1, 2015
Article: Depression rather than liver impairment reduces quality of life in patients with hepatitis C—LD Silva, et al
  Source: Rev Bras Psiquiatr. 2015 Jan-Mar;37(1):21-30. doi: 10.1590/1516-4446-2014-1446
 
Results and Conclusion: In
the current study there were 124 patients (72 females; 52 males; mean
age 53 yo).  The patients were given various clinical and psychiatric
evaluations.  No patients were receiving HCV treatment.  Various
in-person interviews were given to determine socio-economic information,
health-related quality of life, income, smoking, alcohol and drug
use. 
The study results found that
30.6% had major depressive disorder, which is consistent with other
studies. The degree of major depressive disorder and other psychiatric
disorders found in people with hepatitis C is associated with
health-related quality of life rather than tied to the degree of liver
fibrosis.  The authors noted that more attention needs to be devoted to
“the implementation of integrated medical, psychiatric, and [that]
psychological care may be helpful.”
 
The Bottom Line: Up to 70% of people
with chronic hepatitis C have depressive disorders—this is a seven-fold
higher rate than the general population.
 
Editorial Comment: Does
HCV cause depression?  Many experts believe that the hepatitis C virus
causes depression, but the exact mechanism hasn’t been completely
understood.  There have been some studies that have shown that the
hepatitis C virus passes the blood-brain barrier and there have been
viral particles found in brain tissue.  Another possible reason for
depressive disorders could potentially be the results of the immune
system cells fighting off the virus in brain tissue.   
Regardless of what causes
depression in people with hepatitis C, it is clear that curing hepatitis
C also can increase the quality of life leading to a wide variety of
improvements in health including mental health. It’s time that we
recognize that we should treat everyone with hepatitis C regardless of
the degree of liver damage—hepatitis C is NOT just a liver disease.
 
Article:
Changes in characteristics of hepatitis C patients seen in a liver
center in the United States during the last decade—N Talaat et al.
  Source: Journal of Viral Hepatitis Volume 22,Issue 5, pages 481–488, May 2015
 
Results and Conclusion: This
was a retrospective study of the records of patients seen in liver
clinics 1998-1999 (Era-1) compared to the records of patients seen
2011-2012 (Era-2)
The current study sought to
describe the characteristics of people with HCV who were newly referred
to liver clinics in Era-1 (538 patients). The records from Era-1
patients were compared to those of patients who were seen in Era-2 (810
patients).  Advanced liver disease was defined as cirrhosis,
decompensated cirrhosis, or liver cancer.  
The patients in Era-2 were older
(median age 56 vs 45 years), more likely to be Black (17.2% vs 11.6%)
and had a longer interval between diagnosis and referral (median 4
years vs 2 years).  Genotype 1 was similar in both Era’s, but genotype
1a was 39.9% vs 53.8% in Era-2.  
Even though there was a higher percentage of
treatment-experienced patients in the Era 2 patient group, the
comparison showed that more than three quarters of the patients had
never been treated.    
Era-2 patients were more likely
to have advanced disease at referral (61.6% vs 51.5%)—with an  
eightfold higher prevalence of HCC or liver cancer (21.6% vs 2.6%).
 
The Bottom Line: 
The changes in the Era-2 patients points to important trends in the
hepatitis C population.  These changes occurred over a relatively short
period of time:   
  • The majority of patients identified had not been treated.
  • More patients had HCV
    genotype 1a – generally a more difficult genotype/subtype to treat. 
    This also reflects a change in the demographics of the HCV population
    of the United States.
  • The aging of the HCV population is reflective of more advanced disease including an eight-fold increase in liver cancer.

Editorial Comment: 
This study speaks volumes.  In this short period of time there has
been a major advance in the rate of liver disease progression—most
notably the increase in liver cancer is frightening.  

http://hcvadvocate.org/news/newsLetter/2015/advocate0515.html#4

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Snapshots —Alan Franciscus, Editor-in-Chief

Posted on by December 13, 2015
Article:  Improvement of health-related quality of life and work productivity in chronic hepatitis C patients with early and advanced fibrosis treated with ledipasvir and sofosbuvir—ZM Younossi
  Source: J Hepatol.2015 Mar 17. pii: S0168-8278(15)00192-0. doi: 10.1016/j.jhep.2015.03.014. [Epub ahead of print]
The main goal of HCV treatment is viral eradication or being cured of hepatitis C. However, there are equally important reasons and objectives besides being cured—better overall mental and physical functioning and being able to increase work productivity (and being able to increase income). 
The aim of the current study was to examine what being cured of hepatitis C with sofosbuvir plus ledipasvir with or without ribavirin means with respect to improving health-related quality of life—mainly physical functioning and work productivity.  There were 1,005 patients in the current study that were drawn for the ION-1,2,3 clinical trials.  The patient’s fibrosis stage was determined pretreatment based on the Metavir fibrosis staging system:
  • F0: 94 patients (pts);
  • F1: 311 pts;
  • F2: 301 pts ;
  • F3: 197 pts;
  • F4:102 pts
Four questionnaires [Chronic Liver Disease Questionnaire-HCV (CLDQ-HCV), Short Form-36 (SF-36), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Work Productivity and Activity Index: Specific Health Problem (WPAI:SHP)] were administered at baseline, during, and after treatment.
The Bottom Line:  It is not surprising that patients with the most advanced fibrosis (F4) had the most impairment in health-related quality of life with respect to physical functioning compared to those who were stage F0. 
This continued during and post-treatment.  After being cured there was a significant improvement from baseline in most areas of health-related quality of life regardless of the level of fibrosis stage. 
After analysis, not surprisingly, advanced fibrosis was associated with impairment of health-related quality of life and work productivity. However, it was noted that health-related quality of life and work productivity after being cured was not related to the stage of fibrosis.
Editorial Comment: This is an important study because it proved that curing people of hepatitis C improved physical well-being and work productivity.  I am eager to see more of these types of studies because we all need more information about every aspect of being cured of hepatitis C—this helps people living with hepatitis C to make the treatment decision and it will further justify the expense and need to treat people with hepatitis C.
Abstract: Chronic hepatitis C virus infection and lymphoproliferative disorders: Mixed cryoglobulinemia syndrome, monoclonal gammopathy of undetermined significance, and B-cell non-Hodgkin lymphoma—GP Caviglia
  Source: J Gastroenterol Hepatol.2015 Apr;30(4):742-7. doi: 10.1111/jgh.12837.
The researchers reviewed a study of 1,313 HCV patients who had enrolled in previous studies from January 2006 and December 2013.  There was a total of 121 people with HCV and lymphoproliferative disorders (LPDs) and 130 without LPDs.  The two groups were evenly divided between age and gender.  In the groups with LPDs—25 had mixed cryoglobulinemia (MCS)*; 55 had monoclonal gammopathy of undetermined significance (MGUS)**; 41 had B-cell non-Hodgkin Lymphoma (B-HNL)***.  The patients with LPDs did not differ in age, severity of disease, HCV genotype, and response HCV therapy. 
The Bottom Line:  After analyzing the data, it was found that there was an association between MGUS and B-NHL and cirrhosis, but there was no association between MCS and cirrhosis. 
Editorial Comment:  It is interesting that there was a correlation between MGUS and cirrhosis.  However, both conditions typically take many years before serious disease progression occurs.  In regards to MCS it can occur earlier in the course of HCV infection.  Still, it is important that people living with hepatitis C understand this information and talk with their medical providers to be tested for these conditions and for medical providers to make sure they are tested.  If someone infected with hepatitis C does have these serious conditions they may be more likely to qualify for treatment.  It would be, however, best medical and patient practice to nip these and HCV in the bud by treating and curing hepatitis early before any disease or associated condition has a chance to occur. 
*Mixed cryoglobulinemia (MCS) is one of the most common disorders associated with hepatitis C.  Cryoglobulinemia (cryo for short) is a blood disorder caused by abnormal proteins in the blood called cryoglobulins that precipitate or clump together when blood is chilled and then dissolve when warmed.  Cryo can lead to many other disorders. 
**Monoclonal gammopathy of undetermined significance (MGUS) are abnormal proteins in the blood.   They can be associated with another disease (such as hepatitis C).  They rarely cause disease, but in some people with certain conditions, such as hepatitis C, MGUS’s can progress to other diseases. 
***B-cell non-Hodgkin Lymphomas (B-HNL) are cancers of the lymphoid tissues.  The cancers are typically uncommon and usually occur after many years of infection with hepatitis C. 
More detailed information can be found on our fact sheet page.
http://hcvadvocate.org/news/newsLetter/2015/advocate0415_mid.html#1
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Snapshots —Alan Franciscus, Editor-in-Chief

Posted on by December 1, 2015
Article: 
Improvement of health-related quality of life and work productivity in
chronic hepatitis C patients with early and advanced fibrosis treated
with ledipasvir and sofosbuvir—ZM Younossi
  Source: J Hepatol.2015 Mar 17. pii: S0168-8278(15)00192-0. doi: 10.1016/j.jhep.2015.03.014. [Epub ahead of print]
The main goal of HCV treatment
is viral eradication or being cured of hepatitis C. However, there are
equally important reasons and objectives besides being cured—better
overall mental and physical functioning and being able to increase work
productivity (and being able to increase income). 
The aim of the current study was
to examine what being cured of hepatitis C with sofosbuvir plus
ledipasvir with or without ribavirin means with respect to improving
health-related quality of life—mainly physical functioning and work
productivity.  There were 1,005 patients in the current study that were
drawn for the ION-1,2,3 clinical trials.  The patient’s fibrosis
stage was determined pretreatment based on the Metavir fibrosis staging
system:
  • F0: 94 patients (pts);
  • F1: 311 pts;
  • F2: 301 pts ;
  • F3: 197 pts;
  • F4:102 pts
Four questionnaires [Chronic
Liver Disease Questionnaire-HCV (CLDQ-HCV), Short Form-36 (SF-36),
Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F),
Work Productivity and Activity Index: Specific Health Problem
(WPAI:SHP)] were administered at baseline, during, and after treatment.

The Bottom Line: 
It is not surprising that patients with the most advanced fibrosis
(F4) had the most impairment in health-related quality of life with
respect to physical functioning compared to those who were stage F0. 
This continued during and
post-treatment.  After being cured there was a significant improvement
from baseline in most areas of health-related quality of life
regardless of the level of fibrosis stage. 

After analysis, not
surprisingly, advanced fibrosis was associated with impairment of
health-related quality of life and work productivity. However, it was
noted that health-related quality of life and work productivity after
being cured was not related to the stage of fibrosis.

Editorial Comment:
This is an important study because it proved that curing people of
hepatitis C improved physical well-being and work productivity.  I am
eager to see more of these types of studies because we all need more
information about every aspect of being cured of hepatitis C—this helps
people living with hepatitis C to make the treatment decision and it
will further justify the expense and need to treat people with
hepatitis C.
Abstract: Chronic
hepatitis C virus infection and lymphoproliferative disorders: Mixed
cryoglobulinemia syndrome, monoclonal gammopathy of undetermined
significance, and B-cell non-Hodgkin lymphoma—GP Caviglia
  Source: J Gastroenterol Hepatol.2015 Apr;30(4):742-7. doi: 10.1111/jgh.12837.
The researchers reviewed a study
of 1,313 HCV patients who had enrolled in previous studies from
January 2006 and December 2013.  There was a total of 121 people with
HCV and lymphoproliferative disorders (LPDs) and 130 without LPDs.  The
two groups were evenly divided between age and gender.  In the groups
with LPDs—25 had mixed cryoglobulinemia (MCS)*; 55 had monoclonal
gammopathy of undetermined significance (MGUS)**; 41 had B-cell
non-Hodgkin Lymphoma (B-HNL)***.  The patients with LPDs did not
differ in age, severity of disease, HCV genotype, and response HCV
therapy. 
The Bottom Line: 
After analyzing the data, it was found that there was an association
between MGUS and B-NHL and cirrhosis, but there was no association
between MCS and cirrhosis. 
Editorial Comment: 
It is interesting that there was a correlation between MGUS and
cirrhosis.  However, both conditions typically take many years before
serious disease progression occurs.  In regards to MCS it can occur
earlier in the course of HCV infection.  Still, it is important that
people living with hepatitis C understand this information and talk
with their medical providers to be tested for these conditions and for
medical providers to make sure they are tested.  If someone infected
with hepatitis C does have these serious conditions they may be more
likely to qualify for treatment.  It would be, however, best medical
and patient practice to nip these and HCV in the bud by treating and
curing hepatitis early before any disease or associated condition has a
chance to occur. 

*Mixed cryoglobulinemia (MCS)
is one of the most common disorders associated with hepatitis C. 
Cryoglobulinemia (cryo for short) is a blood disorder caused by abnormal
proteins in the blood called cryoglobulins that precipitate or clump
together when blood is chilled and then dissolve when warmed.  Cryo can
lead to many other disorders. 

**Monoclonal gammopathy of undetermined significance (MGUS)
are abnormal proteins in the blood.   They can be associated with
another disease (such as hepatitis C).  They rarely cause disease, but
in some people with certain conditions, such as hepatitis C, MGUS’s can
progress to other diseases. 

***B-cell non-Hodgkin Lymphomas (B-HNL)
are cancers of the lymphoid tissues.  The cancers are typically
uncommon and usually occur after many years of infection with hepatitis
C. 
More detailed information can be found on our fact sheet page.
http://hcvadvocate.org/news/newsLetter/2015/advocate0415_mid.html#1
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Hepatitis C in Children: Comorbidities and Quality of Life

Posted on by December 1, 2015

According
to the CDC, hepatitis C virus (HCV) infection is a common chronic
disease that currently affects about 3.2 million people in the United
States,1 and although less common it remains a significant health problem in children, according to the American Liver Foundation.2

On the second day at The Liver Meeting 2014, an annual
meeting organized by the American Association for the Study of Liver
Diseases, held in Boston, Massachusetts, from November 7th to 11th,
2014, 2 studies evaluated the impact of HCV infection and treatment in
children.

Presented during the Behavioral, Quality of Life, and Practice Issues
poster session, researchers studied family members, caregivers, and the
children who were being treated for HCV infection, through an
assessment packet that was given before and immediately after treatment,
before the treatment outcome was known. According to the authors,
earlier research has examined a wide range of patient psychosocial
outcomes but little is known about the impact of HCV and the prolonged
treatment on caregivers and families. Among the 10 children that were a
part of the study, the average age of the patients was 11.62 years, and 6
were female. The psychosocial parameters evaluated included patient
quality of life, parental distress related to the child’s illness, and
general family functioning. –

See more at:
http://www.ajmc.com/conferences/AASLD2014/Hepatitis-C-in-Children-Comorbidities-and-Quality-of-Life-#sthash.FI0cGB7x.dpuf

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Predictors of poor mental and physical health status among patients with chronic hepatitis C infection: The chronic hepatitis cohort study (CHeCS)

Posted on by December 1, 2015

—Alan Franciscus, Editor-in-Chief     

It should not surprise anyone with hepatitis C (HCV) that having
hepatitis C can lead to depressive symptoms and a reduction in quality
of life.   Would it be a surprise that being cured of hepatitis C
would reduce the symptoms of depression and improve quality of life? 
Probably not!  I will be very interested to read the entire research
paper about this study to learn more. 

Lucinda Porter, RN will report on another study
that looked at people who had minimal disease who had to wait for
treatment and what effect it had on their emotional state.  The recap
of the study will appear in the next issue of the HCV Advocate newsletter.   Alan

Predictors of poor mental and physical
health status among patients with chronic hepatitis C infection: The
chronic hepatitis cohort study (CHeCS).
Boscarino et al.

Hepatology. 2014 Sep 9. doi: 10.1002/hep.27422. [Epub ahead of print]

ABSTRACT

Aims:
Our objective was to assess the extent and risk
factors for depression and poor physical health among patients with
chronic hepatitis C virus (HCV) infection.

Methods:
We surveyed HCV-infected patients seen at four
large healthcare systems participating in the Chronic Hepatitis Cohort
Study (CHeCS).

Survey data included demographics, depression and
physical health measures, substance use history, current social
support, recent stressor exposures, and, from the electronic medical
record, treatment history, and Charlson Comorbidity Index scores.

Results:
There were 4,781 respondents, who were a mean of 57
years old, 71% White, and 57% male. Altogether, 51.4% reported past
injection drug use, 33.9% were current smokers, and 17.7% had abused
alcohol in the previous year. Additionally, 47.4% had been previously
treated for HCV and 14.8% had a 12-week sustained viral response (SVR)
following HCV therapy. Overall, 29.7% of patients met criteria for
current depression and 24.6% were in poor physical health.

In multivariate analyses, significant predictors of depression and poor health included:

  • Male gender (vs. female, OR, 0.70 and 0.81),
  • Black race (vs. white, ORs, 0.60 and 0.61),
  • Having education less than high school (vs. college, ORs, 1.81 and 1.54),
  • Being employed (vs. not, ORs, 0.36 and 0.25),
  • Having high life stressors (vs. low, ORs, 2.44 and 1.64),
  • Having low social support (vs. high, ORs=2.78 and 1.40), and
  • Having high Charlson scores (vs. none, ORs=1.58 and 2.12).

Achieving a 12- week SVR was found to be protective for depression.

Conclusions:
This large survey of US HCV patients indicates the
extent of adverse health behaviors and mental and physical
comorbidities among these patients. (Hepatology 2014;).

Copyright © 2014 American Association for the Study of Liver Diseases.

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Recommendations to Improve Liver Health in Hepatitis B, Hepatitis C Patients

Posted on by December 1, 2015

Although
it is widely understood that hepatitis B virus (HBV) and hepatitis C
virus (HCV) are the leading causes of liver cirrhosis and liver cancer, a
study published in Cancer Nursing reports an alarming number of HBV and HCV carriers have unhealthy habits that result in poor liver health.

To learn about the behavior and attitudes of HBV and HCV carriers, a
team of researchers in China conducted interviews with 6,805
participants from August 2011 to July 2012. The participant pool was
limited to candidates aged 20 years or older who were able to live
independently, could either complete the questionnaire in Mandarin or
Taiwanese, had access to their community hospital, and did not have a
learning disability.

According to the researchers, a notable percentage of participants had
either HBV (18.7%) or HCV (20.8%). Despite reporting risk factors for
poor liver function among HBV and HCV carriers that included “being
overweight, fasting blood sugar levels >110 mg/dL, systolic blood
pressure >140 mm Hg, smoking, betel nut chewing and alcohol
consumption,” the investigators discovered a large percentage of the
study subjects participated in those modifiable hazardous behaviors.

 –
See more at:
http://www.hcplive.com/publications/contagion/2014/august2014/Recommendations-to-Improve-Liver-Health–in-Hepatitis-B-Hepatitis-C-Patients#sthash.lsnkS4YU.dpuf

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HCV prevalence, cost burden continue to rise

Posted on by February 26, 2014

The hepatitis C virus has a profound negative impact on patients’
quality of life, both in its clinical manifestations and its overall
economic burden, according to recent study data.

A panel of
hepatologists, experienced with evidence assessment, was convened to
estimate how HCV affects patient outcomes. The researchers used the
Grading of Recommendations Assessment, Development, and Evaluation
(GRADE) methodology.

Younossi ZM. Aliment Pharmacol Ther. 2014;39:518-531.
Read more…

 

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