Fatigue Before, During and After Antiviral Therapy of Chronic Hepatitis C: Results from the Virahep-C Study.

Fatigue is the most frequent and often debilitating symptom of chronic hepatitis C. It is unclear whether successful therapy of hepatitis C leads to its clinical improvement. In the Virahep-C study, patients with hepatitis C virus (HCV) genotype 1 infection were treated with peginterferon alfa-2a and ribavirin for up to 48 weeks while undergoing assessment of viral kinetics and clinical symptoms. METHODS:Fatigue measurements were conducted, before, during and after therapy, as 'presence' (yes/no) and 'severity' (visual analogue scale: 0 to 100mm). The clinical, histologic and virologic features that correlated with the presence and degree of fatigue were assessed focusing upon changes associated with sustained virological response (SVR).RESULTS:At baseline, 52% (n= 401) participants reported having fatigue, which was more common in women than men (59% vs. 48%, p=0.02) and slightly more severe (30 vs. 22mm, p=0.056). Fatigue was frequent and worse in cirrhotics versus those with lesser fibrosis (66% vs. 49%; 34 vs. 24mm). Fatigue did not correlate with other parameters. The proportion of patients and median fatigue scores increased on treatment (52% to 78%; 25 to 40mm, p<0.0001) with higher fatigue noted amongst those who ultimately achieved SVR (p<0.0001). On achieving SVR, there was a significant decrease in both frequency and severity of fatigue compared to their baseline (53% to 33%; 27 to 13mm, both p<0.0001).CONCLUSION:Fatigue is common in patients with chronic hepatitis C but associated poorly with biochemical parameters. Sustained response is accompanied by substantial improvement of fatigue.