Fatigue does not correlate with the degree of hepatitis or the presence ofautoimmune disorders in chronic hepatitis C infection

Background Fatigue is probably the most commonly reported symptom in chroni c hepatitis C virus (HCV) infection. It is unclear whether fatigue is relat ed to the severity of underlying liver disease or other autoimmune disorder s often described with chronic HCV infection. Objective To quantify fatigue in terms of its impact on quality of life in a homogeneous cohort and examine its relationship to the status of liver di sease or associated autoimmunity. Methods The Fatigue Impact Scale (FIS) questionnaire (Fisk ef al. Clin infe ct Dis 1994; 18:S79 -S83), a recently validated psychometric tool for asses sing patients' perceptions of the functional limitations attributable to fa tigue (40 statements; three subscales: physical, cognitive and psychologica l; maximum score = 160), was applied to a cohort of Irish women who were PC R-positive for HCV genotype Ib via inoculation with contaminated anti-D pro ducts in 1977. RIBA-positive, PCR-negative patients (n = 20) and healthy ag e-matched women (n = 50) served as controls, The degree of hepatitis was as sessed using the Knodell histological activity index (HAI) score on previou s liver biopsies. Clinical and laboratory evidence of cryoglobulinaemia, Sj ogren's syndrome, connective tissue diseases, autoimmune thyroid disease an d glomerulonephritis was sought, Results The mean FIS score of the 66 PCR-positive women (mean 78 +/- 36; ra nge 7-153) was significantly higher than in age-matched controls (mean 31 /- 24, range 0-78, P< 0.001) but not statistically different from that of t he RIBA-positive, PCR-negative group. The FIS score did not correlate with the HAI score (median HAI = 4; range 2-9; Pearson's correlation coefficient r = 0.01, P = 0.9). Significant levels of cryoglobulins were detected in 1 0 (15.2%). The sicca complex was diagnosed in six patients, three of whom h ad associated cryoglobulinaemia. Thyroid antibodies, anti-nuclear antibody, rheumatoid factor, antimitochondrial antibody and anti-smooth muscle antib ody were detected in 15.2%, 6%, 4.5%, 4.5% and 1.5%, respectively. There wa s no significant difference in the FIS score between the groups with autoim mune diseases and those without. The FIS score of the nine patients previou sly treated with interferon was not statistically different from the untrea ted group (P = 0.39). Conclusion The perceived functional impact of fatigue on quality of life is significantly higher in patients with chronic HCV genotype Ib infection co mpared to healthy controls. However, it is unrelated to the degree of hepat itis and cannot be accounted for by the co-existence of autoimmune disorder s alone. fur I Gastroenterol Hepatol 11:833-838 (C) 1999 Lippincott William s & Wilkins.