Fatigue in patients with chronic hepatitis C

Abstract

In numerous studies of symptoms in patients with chronic hepatitis C there has been no systematic assessment of both fatigue and extrahepatic manifestations. Our objective was to assess the prevalence of fatigue in patients with hepatitis C virus (HCV) infection, and to identify associations between fatigue and clinical and biological hepatic and extrahepatic manifestations. We studied 1614 patients. Data were prospectively recorded during the first visit of patients infected with HCV and the prevalence of fatigue and its association with dermatological, rheumatological, neurological and nephrological manifestations; diabetes; arterial hypertension; auto-antibodies, and cryoglobulinaemia were assessed. Then, using multivariate analysis, we identified demographic, biochemical, immunological, virological, and histological factors associated with the presence of fatigue. Fatigue was present in 53% of patients (95% confidence interval 51-56). In 17% of patients (95% confidence interval 15-19) fatigue was severe, impairing activity. Five other extrahepatic manifestations had a prevalence above 10% including, in decreasing order: arthralgia, paresthesia, myalgia, pruritus, and sicca syndrome. In univariate and multivariate analyses, fatigue, in comparison with the absence of fatigue, was associated with female gender, age over 50 years, cirrhosis, depression and purpura. Independent of these associations, fatigue was associated with arthralgia, myalgia, paresthesia, sicca syndrome and pruritus. The prevalence of fibromyalgia (as defined by the association of fatigue with arthralgia or myalgia) was 19% (95% confidence interval 17-21). There was no significant association between fatigue and the following characteristics: viral load or genotype, alcohol consumption, abnormal thyroid function, and type and level of cryoglobulinaemia. Hence, fatigue is the most frequent extrahepatic manifestation in patients infected with HCV. Fatigue is independently associated with female gender, age over 50 years, cirrhosis, depression and purpura.

The effects of HCV infection and management on health-related quality of life

“…33 Kramer et al 34 found significant fatigue in 120 untreated patients with CHC compared with healthy controls using the Fatigue Impact scale (49 versus 26 points) and the Brief Fatigue Inventory (3.0 versus 1.6 points; P Ͻ 0.001). In another study, Poynard et al 35 studied 1,614 patients with CHC to determine the association between fatigue and other clinical and biological extrahepatic manifestations of CHC. Fatigue was reported in 53% of patients and was disabling in 17%, 35 findings consistent with those of other studies in which the prevalence ranged from 50% to 67%.…”

Fibromialgia e infecção crônica pelo vírus da hepatite C: ausência de associação em duas amostras

“…Ao contrário de outras pesquisas (18)(19)(20)(21)(22)(23) , os resultados obtidos sugerem que o VHC, aparentemente, não desempenha nenhum papel na patogenia da fibromialgia, embora a falta de evidências aqui detectada não represente, necessariamente, a ausência da associação.…”

“…É fato que a fibromialgia constitui uma condição clínica freqüente (29) e, em estudos não-controlados, pode ser detectada em um número por vezes expressivo de pacientes, por mera questão de chance. Isso é o que se observa nas séries de casos obtidas a partir de uma amostra de pacientes cronicamente infectados (8,19,21,23) .…”

“…O cálculo das amostras levou em consideração uma prevalência da infecção crônica pelo VHC, em pacientes do sexo feminino com o diagnóstico de fibromialgia, variando entre 5,0% e 30,0% em diferentes estudos da literatura (18)(19)(20)(21)(22)(23) ; uma prevalência, variando entre 1,0% e 11,0% da infecção crônica pelo VHC em pacientes com o diagnóstico de DDTC. Foram consideradas as prevalências observadas para a artrite reumatóide (28) e o lúpus eritematoso sistêmico (16,17) , uma vez que representam as patologias mais freqüentes do grupo DDTC.…”

“…A fibromialgia também tem sido considerada como muito prevalente em pacientes infectados pelo VHC, especialmente mulheres (18)(19)(20)(21)(22)(23) .…”