Assessment of Fatigue and Psychologic Disturbances in Patients with Hepatitis C Virus Infection
     J Clin Gastroenterol 2001 May;32(5):413-417 Obhrai J, Hall Y, Anand BS.
Digestive Diseases Section, Baylor College of Medicine (J.O., Y.H., B.S.A.), Houston, Texas, U.S.A.; and Veterans Administration Medical Center (B.S.A.), Houston, Texas, U.S.A.

For additional reading, see HCV and Brain Dysfunction.

BACKGROUND:
It is a common clinical impression that fatigue is a frequent, and often debilitating, symptom in patients with chronic hepatitis C virus (HCV) infection. However, despite its obvious clinical importance, several aspects of fatigue, including its relationship with the underlying liver disease and the presence of psychologic disturbances, have not been well examined.

GOALS:
The current study was carried out to assess these issues.

STUDY:
A total of 149 subjects were included in the study and were assigned to one of the following study groups: healthy controls (31), chronic HCV infection (24), combined HCV infection and chronic alcohol abuse (32), alcoholic liver disease (22), and chronic non-liver diseases (40). All subjects were administered investigator-assisted questionnaires designed to analyze the presence and severity of fatigue and psychologic abnormalities.

RESULTS:
The mean (+/-SD) fatigue scores in patients with chronic HCV infection (140 +/- 22.9; p = 0.002), alcoholic liver disease (127 +/- 31.4; p < 0.001), mixed (HCV/alcoholic) liver disease (131 +/- 29.0; p < 0.001), and chronic non-liver diseases (128 +/- 35.9; p = 0.004) were significantly

greater compared to with healthy subjects (101 +/- 31.8). The total fatigue scores were higher in HCV-infected subjects compared with the other patient groups, but the differences failed to reach statistical significance. Moreover, the fatigue experienced by patients with HCV did not improve with rest as effectively as in the other study groups. All patient groups had higher scores for psychologic disturbances compared with healthy subjects.

CONCLUSIONS:
The current study shows that fatigue and psychologic disturbances occur frequently in chronic diseases. The fatigue experienced by patients with HCV infection is more severe and intransigent and responds poorly to relieving factors. Moreover, patients with HCV infection are more depressed and harbor greater feelings of anger and hostility compared with those with non-liver chronic diseases. These observations are important because proper management of the psychologic symptoms may have a favorable impact on the quality of life of patients with HCV infection.