Fatigue – a common symptom among people living with
hepatitis C virus (HCV) infection – is associated with liver inflammation and
fibrosis, but antiviral therapy that leads to a cure significantly reduces the
likelihood of fatigue, according to a Danish study presented yesterday at the
5th International Symposium on Hepatitis Care in Substance Users (INHSU 2016)
in Oslo, Norway.
Rasmus Thornhøj of Odense University Hospital in
Southern Denmark presented findings from the FAT-HEP study, which looked at
fatigue in relation to chronic HCV infection, current or past substance use,
opioid substitution therapy (OST), liver inflammation and fibrosis, and
sustained response to hepatitis C treatment.
Fatigue is frequently reported by people with chronic
hepatitis C and has a detrimental effect on quality of life, though its
pathophysiology is not yet fully understood.
A non-invasive test, used instead of a biopsy, to measure the stiffness
or elasticity of the liver using an ultrasound probe.
"People can't do the things they normally would,
and they may have trouble staying in a job," Thornhøj said.
Last year the European Association for the Study of
the Liver (EASL) recommended that debilitating fatigue should be among the
indications for prioritising hepatitis C treatment.
This cross-sectional, questionnaire-based study,
conducted from September to November 2015, used the Fatigue Severity Scale
(FSS), the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F)
measure and the Fatigue Visual Analogue Scale (VAS-F).
The analysis included 56 people with hepatitis C seen
at an outpatient clinic in Denmark. Of these, 30% were current substance users,
54% had a history of previous substance use and 36% were on OST.
More than two-thirds of study participants (68%)
reported clinically significant fatigue with an FSS score of 4 of higher.
Fatigue was more common among people with current
substance use (odds ratio [OR] 2.9; p = 0.14), past substance use (OR 1.7;
p = 0.35) or use of OST (OR 2.55; p = 0.15), but none of these associations were
Clinically meaningful fatigue was, however,
significantly associated with liver disease severity measures. People with
liver inflammation, indicated by an alanine aminotransferase level > 30 IU/ml
for men or 19 IU/ml for women, had more than a fivefold higher likelihood of
fatigue (OR 5.3; p = 0.01). Those with a FibroScan transient elastometry score
> 12 kPa, indicating a high probability of advanced fibrosis (stage F3) or
cirrhosis (F4), had nearly a sixfold higher likelihood of fatigue (OR 5.8; p = 0.03).
Successful hepatitis C treatment appeared to improve
fatigue. Participants who achieved a sustained virological response at 12 weeks
after completion of antiviral treatment (SVR12) had a much lower likelihood of
clinically meaningful fatigue (OR 0.2; p = 0.02).
The researchers concluded that fatigue in people
living with chronic hepatitis C cannot be solely explained by substance use or
opioid substitution therapy, but it could be linked to HCV-related measures
including liver inflammation, fibrosis and sustained treatment response.
Thornhøj suggested that as treating this group of
patients seems to reduce fatigue, this provides further support for prompt