Análise dos resultados relatados pelos pacientes (PROs) com hepatite crônica C submetidosà terapia com antivirais de ação direta e livre de interferon

Abstract

The new therapeutic regimens for the treatment of chronic interferon-free hepatitis C have high rates of sustained virological response and low incidence of adverse events. Viral eradication has been associated with improved quality of life related to patient health. The objective of this study was to assess health-related quality of life and fatigue in patients with chronic hepatitis C treated with interferon-free direct-acting antiviral agents who obtained sustained virological response after treatment and to identify predictive factors related to the quality of life.Methods:Prospective cohort study that included patients with chronic hepatitis C treated with second-generation direct-acting antivirals who achieved sustained virological response after treatment. The patients answered two questionnaires to assess health-related quality of life: one generic (Short Form-36) and another specific for chronic liver diseases (Chronic liver disease questionnaire) and one for fatigue assessment (Functional assessment of chronic illness therapy -fatigue). All patients were interviewed before treatment, at weeks 6 and 12 of therapy and 12 weeks after their end. The scores of the patients' self-reported reports were compared using analysis of variance (ANOVA of repeated measures). The patients were divided into 2 groups: group with ribavirin and group without ribavirin, Student's t test was performed to verify the impact of the use of ribavirin on the patients' quality of life and fatigue. Predictive factors were calculated using a multivariate linear regression model.Results:Of the 113 selected patients, 105 obtained a sustained virological response and were included in the study. Among the patients, 54% were men, 80% infected with genotype 1, 44% cirrhotic and 46% were treated with regimens containing ribavirin. Twelve weeks after the end of treatment, there was a significant improvement in the patients' quality of life scores when compared to the baseline scores of the Chronic Liver Disease Questionnaire (+ 10.52%, p<0.00), of the Short Form-36 -summarized physical component (+ 19%, p <0.00) and Functional Assessment of Chronic Illness Therapy-Fatigue (+ 17.34%, p <0.001). The group that used ribavirin in the treatment had lower fatigue and quality of life scores than the group that did not use it at weeks 6 and 12 of treatment. The presence of diabetes mellitus, liver cirrhosis, being co-infected with HIV and the use of ribavirin were negative predictors of quality of life.Conclusion:Patients treated with IFN-free regimens show significant improvement in quality of life and fatigue. The presence of diabetes mellitus, liver cirrhosis and HIV co-infection is a negative predictor of quality of life and fatigue before, during and after treatment of hepatitis C.The addition of ribavirin to the antiviral regimens used compromises the quality of life indexes during antiviral therapy.