QUALITY OF LIFE FOLLOWING ANTIVIRAL THERAPY FOR CHRONIC HCV INFECTION

Purpose: To compare the health status of patients with a sustained response to anti-viral therapy for hepatitis C virus (HCV) infection to that of non-responders, using health related quality of life and preference (utility) measures.

Methods: Patients were recruited from three liver specialist clinics in Vancouver, Canada. Sustained responders had undetectable HCV viral levels six months following antiviral therapy. After response to therapy had been determined, participants completed, by mail or interview, the Hepatitis-specific Medical Outcomes Survey Short-Form-36 (SF-36), Health Utilities Index Mark 2/3 (HUI2/3), and time-tradeoff (TTO) for current health, and provided information on demographics, substance abuse history, co-morbidities (for the Charlson score) and health history (for the symptom severity index score). Detailed clinical information was obtained by chart review. Means and proportions were compared between sustained responders and non-responders using t-tests and chi-square tests, respectively. HUI2, HUI3 and time trade-off scores of sustained responders and non-responders were compared using linear regression, adjusting for potential confounding variables.

Results: 322 patients had received antiviral therapy; after excluding patients with hepatocellular carcinoma, decompensated cirrhosis, or transplantation, 298 remained (150 responders and 148 non-responders). Non-responders were more likely to be male, unemployed, have cirrhosis and be infected with genotype 1/4 (p<0.0001). Non-responders had higher mean Charlson co-morbidity score (1.9 versus 1.3) and higher symptom severity indices (4.8 versus 2.3) (p<0.0001). No differences were observed in age, ethnicity, marital status, education level, total income from all sources, history of injection drug use and excessive alcohol consumption. Non-responders had significantly lower mean scores on the eight SF-36 domains, the four Hepatitis specific domains, and lower mean physical (41 versus 48) and mental (41 versus 46) component summary scores (p<0.01). Utilities from time trade-off (0.81 versus 0.89), HUI2 (0.73 versus 0.80) and HUI3 (0.57 versus 0.70) were lower for non-responders (p<0.0001). The regression-adjusted difference in HUI2 scores was less than 0.01 (p=0.96). Similarly, there were no differences in the HUI3 and time-tradeoff scores between responders and non-responders after adjustment for demographic and clinical variables.

 Conclusion: Patients with a sustained response to antiviral therapy for chronic HCV infection have better quality of life than non-responders. In our population, the difference in quality of life measures appears to be explained by differences in demographics, comorbidity and symptoms.