Comorbidities and quality of life in patients with interferon-refractory chronic hepatitis C

OBJECTIVES: Patients with chronic hepatitis C (HCV) consistently report a r eduction in multiple domains of health-related quality of life (HRQOL) that does not correlate with liver disease severity. This may in part be due to the use of insensitive HRQOL instruments or extrahepatic factors that inde pendently influence HRQOL. We hypothesized that a past history of substance abuse or active medical and psychiatric comorbidities would correlate with HRQOL scores. METHODS: In 107 patients who had failed previous interferon therapy, HRQOL was measured by using the modified SF-36, a disease-specific instrument, an d the Health Utilities Index (HUI) Mark III, a generic instrument. RESULTS: Multiple SF-36 subscale and summary scores as well as the HUI Mark III attributes of emotion and pain were significantly reduced in the study population compared with healthy controls (p < 0.001). Serum alanine amino transferase and HCV RNA levels, HCV genotype, liver histology, and HCV risk factors as well as demographic variables did not correlate with modified S F-36 and HUI scores. In addition, a history of alcohol abuse or dependency and intravenous drug use or dependency, identified in 52 and 51% of partici pants, respectively, did not correlate with HRQOL scores. However, the pres ence of one or more active medical comorbidities, defined as a chronic medi cal condition requiring treatment and monitoring, was significantly associa ted with both the modified SF-36 scores and HUI attribute deficits (p < 0.0 01). In particular, painful medical comorbidities or depressed mood requiri ng treatment were significantly associated with modified SF-36 scores and w ith HUI attribute deficits and utility scores (p < 0.001). CONCLUSIONS: Active medical and psychiatric comorbidities may account for s ome of the reduction and variability in HRQOL scores in patients with chron ic HCV who have failed previous interferon therapy. Future studies that con trol for the presence of active comorbidities in large groups of treatment naive patients with varying severity of chronic HCV ape needed to confirm t hese findings. (Am J Gastroenterol 2001;96:170-178. (C) 2001 by Am. Coll. o f Gastroenterology).