Introduction Cirrhosis and chronic infection with Hepatitis C Virus (HCV) is associated with fatigue, depression and neurocognitive deficits which profoundly affect health-related quality of life (QoL). Advances in antiviral therapy mean ~95% of patients receiving treatment achieve sustained virologic response (SVR), reducing progression to cirrhosis. Whether these improved clinical outcomes translate to improvements in QoL has not been empirically assessed. Therefore, this study examined the relationship between the presence of viraemia, fibrosis status and comorbidities on QoL in patients with HCV.

Methods Patients with HCV were recruited prospectively from viral hepatitis clinics at the Freeman Hospital, Newcastle upon Tyne. Data regarding patient’s virus status, fibrosis status, co-morbidities, and lifestyle behaviours were obtained, alongside QoL using a validated question (the Hepatitis Quality of Life Questionnaire; HQLQv2). In all domains of the questionnaire higher scores imply a better QoL.

Results 100 patients were recruited (67% male, 93% white, median age 52 years, median BMI 28.6 kg/m²), of which 71% had achieved SVR and 34% had advanced fibrosis/cirrhosis. 53% of patients had a diagnosis of depression. With the exception of the hepatitis specific limitations scale (HLIM), patients diagnosed with depression and those with a reduced level of physical activity scored significantly lower in all components of the HQLQv2 questionnaire (all p<0.05). The median physical functional component score was significantly lower in patients with advanced fibrosis/cirrhosis (38.6) compared to those without (47.4, p=0.012). Patients who achieved SVR scored significantly higher on the positive wellbeing score, HLIM, and the hepatitis specific health distress scale (HHD) compared to those with detectable HCV RNA (p=0.035, p=0.029 and p=0.004, respectively). Multivariable linear regression adjusted for age, gender, BMI and level of physical activity illustrated that both the presence of depression (aOR-19.85 95%CI -34.37—5.32, p=0.008) and achieving SVR (aOR 20.63 95%CI 4.02–37.24, p=0.016) were independently associated with the HHD score.

Conclusions Our data, from a real world setting, suggests that achieving SVR is associated with an improvement in QoL by reducing physical, mental and emotional limitations associated with HCV. Depression is also highly prevalent in this population and independently impacts upon patients QoL. This suggests the importance of utilising a holistic approach when assessing these patients.