Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, 27 Bd Jean Moulin, 13385, Marseille, France.
Hôpital St Joseph, Service d'Hépato-Gastroentérologie, Marseille, France.
Qual Life Res. 2023 Dec;32(12):3427-3438. doi: 10.1007/s11136-023-03496-w. Epub 2023 Aug 16.
Hepatitis C virus (HCV) cure after treatment with direct-acting antivirals (DAAs) can improve health-related quality of life (HRQoL). However, specific groups with chronic HCV may still exhibit worse post-cure HRQoL because of persisting severe liver fibrosis or social vulnerability factors (e.g. unhealthy alcohol use, living in poverty). We assessed the effect of such factors on longitudinal measures of HRQoL in chronic HCV patients.
ANRS CO22 HEPATHER is a prospective cohort of chronic HCV patients receiving DAAs, which included notably patients with social vulnerability factors, a population usually under-represented in clinical trials. Multivariable mixed-effects linear regression models helped identify factors associated with longitudinal measures of HRQoL (PROQOL-HCV scores).
At enrolment, 52.4% of the 2740 participants were men, median age was 56 years [interquartile range 50-64], and 21.5% had severe liver fibrosis (FIB-4 > 3.25). Twenty-eight per cent reported current or past unhealthy alcohol use [> 2(3) alcohol units per day for women (men)], and 28.1% were living in poverty (standard of living under 1015€/month per household consumption unit). At first PROQOL-HCV completion, 54.0% of patients were HCV-cured. After multivariable adjustment, people with current or past unhealthy alcohol use, individuals living in poverty, those with severe liver fibrosis, and women had worse HRQoL in the dimensions explored. Conversely, HCV cure was associated with better HRQoL.
Specific socially vulnerable groups of patients with chronic HCV infection still experience impaired HRQoL, independently of HCV cure. Patient-centred interventions, including social support and referral for comorbidities, should be prioritized for them. Trial registration with ClinicalTrials.gov NCT01953458.
慢性丙型肝炎病毒（HCV）患者经直接作用抗病毒药物（DAAs）治疗后实现病毒清除可改善健康相关生活质量（HRQoL）。然而，部分持续存在严重肝纤维化或社会脆弱性因素（如，不健康饮酒、生活贫困）的慢性 HCV 患者，即使实现了病毒清除，其 HRQoL 仍可能较差。本研究旨在评估这些因素对慢性 HCV 患者 HRQoL 纵向指标的影响。
ANRS CO22 HEPATHER 是一项接受 DAA 治疗的慢性 HCV 患者前瞻性队列研究，该研究纳入了具有社会脆弱性因素的患者，该人群通常在临床试验中代表性不足。多变量混合效应线性回归模型有助于确定与 HRQoL 纵向指标（PROQOL-HCV 评分）相关的因素。
在入组时，2740 名参与者中 52.4%为男性，中位年龄 56 岁[四分位间距 50-64]，21.5%存在严重肝纤维化（FIB-4＞3.25）。28%报告目前或既往存在不健康饮酒[女性（男性）＞2（3）个酒精单位/天]，28.1%生活贫困（家庭消费单位每人每月生活水平＜1015 欧元）。首次完成 PROQOL-HCV 评分时，54.0%的患者 HCV 被清除。经多变量校正后，目前或既往存在不健康饮酒、生活贫困、存在严重肝纤维化和女性的 HRQoL 在各维度评分均较差。而 HCV 清除与 HRQoL 改善相关。
慢性 HCV 感染的特定社会脆弱人群仍存在 HRQoL 受损，且与 HCV 清除无关。应优先为这些患者提供以患者为中心的干预措施，包括社会支持和共病管理。临床试验注册：ClinicalTrials.gov NCT01953458。
