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
F0: 94 patients (pts);
F1: 311 pts;
F2: 301 pts ;
F3: 197 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.
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 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
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.
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
Labels: lymphoproliferative disorders, post-treatment QOL, Quality of Life, snapshots