Curative treatment that eliminates
hepatitis C virus (HCV) from the body can reduce central fatigue, one of the most concerning
symptoms associated with chronic hepatitis C, according to research presented at the 49th annual meeting of the European Association for the Study of the Liver (EASL), held recently in London.
Fatigue
is a common and debilitating symptom for many people with hepatitis C. Central
fatigue refers to weakness originating in the central nervous system (the brain
and spinal cord), as opposed to peripheral or physical fatigue that originates
in the muscles.
Fatigue
is also a common side-effect of treatment with interferon and ribavirin.
Ribavirin often causes anaemia, which can
lead to fatigue by reducing the blood's capacity to carry oxygen. New direct-acting antiviral agents allow
people with hepatitis C to either take interferon or ribavirin for a shorter
duration or to avoid them altogether.
Zobair Younossi and
colleagues with Inova Health System in Virginia evaluated changes in fatigue
among people with hepatitis C treated and cured with sofosbuvir, either with
pegylated interferon and ribavirin in the NEUTRINO trial (genotypes 1, 4, 5 and 6) or with ribavirin alone in
the FUSION trial
(genotypes 2 and 3).
The analysis included 413 people who achieved sustained virological response, or undetectable HCV RNA
at 12 weeks after finishing treatment (SVR12). About 60% were men, most were
white, the mean age was 52 years and 18% had liver cirrhosis. At baseline, 12%
of study participants reported fatigue, 18% reported anxiety and 24% each reported
insomnia and depression. During treatment 87% developed anaemia (a haemoglobin
decrease of 2 g/dL or more).
Fatigue was assessed
using three validated questionnaires: Functional Assessment of Chronic Illness
Therapy-Fatigue (FACIT-F), Chronic Liver Disease Questionnaire-HCV (CLDQ-HCV)
and Short Form-36 (SF-36). The researchers focused on items related to both
central fatigue (four items) and peripheral fatigue (nine items).
After achieving sustained response, participants
reported significant improvement in fatigue compared to their pre-treatment scores
using all questionnaires: average 26.9% improvement on the SF-36 vitality scale,
19.8% on the FACIT-F fatigue scale and 10.7% on CLDQ-HCV activity-energy domain.
All items in the questionnaires related to central fatigue showed improvement,
while only two items related to peripheral fatigue did so.
In addition, after
successful treatment the proportion of patients who scored below the general
population norm decreased using all questionnaires: from 32.7% to 27.6% on the SF-36
vitality scale, from 43.4% to 34.6% on the FACIT-F fatigue scale and from 47.9%
to 35.4% on the CLDQ-HCV activity-energy domain.
"Sustained
virologic response is associated with
improvement of fatigue," the researchers concluded. "Central fatigue
is the type of fatigue primarily affected by HCV clearance. Longer follow-up
may be needed to show any potential improvement in peripheral fatigue."