MRC Notes from the Ottawa Jan 15 &16, 1999 conference on HCV. While evrey attempt has been made to ensure accuracy, please keep in mind that these are only my notes.

Darlene

By Dr. Mark Swain, MD

University of Calgary

Health Sciences Center

3330 Hospital Drive NW

Calgary, Alberta T2N 4N1

When we look at the quality of life issues, we can look at:

1. Measurement instruments which attempt to define characteristics of health state

2. Perception of health state depends on many things including:

3. Disease labeling alone affects the health related quality of life (HRQOL)

In general HRQOL issues are:

1. Descriptive- they broadly describ different dimensions of living with the disease (eg. SF-36)

2. Utility assessment.

Questionnaires to determine - in hepatitis C the most common questionnaire is the SP-36. This questionnaire encompasses physical well-being, role functioning and physical limitations, bodily pain, and vitality scoring.

1. Lookout at the continuum from Death to Perfect Health and ask the participant to mark where they feel they are.

2. There is a time trade-off- how many years of perfect health which you trade 10 years of living with your disease as it currently feel?

3. To what extent which you risk death to get rid of your current symptoms? 5 percent chance of death?

1. Benefits

- validated

- accesses how the patient perceives their disease

2. Problems

- subjective

- potential to manipulate

1. Administered sickness impact profile questionnaire to 160 HCV patients enrolled in a treatment protocol.

2. At baseline HCV patients scored significant reworks than the general population control.

3 . Work, sleep, rest, and recreation showed the greatest impairment.

4. Interferon improved all scores whether or not they obtained a sustained response.

1. 72 patients in the U.K. were given SF- 36 and compared to healthy controls. n = 6402

2. There was a significant decrease in HRQOL. There was no correlation to symptoms, ALT levels, or scarring of the liver.

1. S F-36 adapted to HCV.

2. 157 patients in an Interferon study were compared to help the controls.

3. There was a significant decrease in all areas.

4. The results were similar to diabetes.

5. There was no correlation with a degree of disease.

1. 642 HCV patients in treatment with Interferon.

2. 24 weeks after completion of interferon they were given assessment.

3. These results were compared to 450 to healthy controls.

4. They scored significantly lower for all 8 scales in HCV

- most significant in physical

- similar scores in patients with cirrhosis and without cirrhosis.

5. Interferon SVRs ( sustained viral responsders) greater improvement than nonSVR

- patients with ALT normal levels but positive for viremia also felt good even though they were non responders.

1. 50 HCV patient were given NIMH diagnostic test.

2. 34 percent demonstrated significant depression or anxiety.

1. 93 Irish and women-57 were RNA HCV positive and 36 were negative.

2. Both showed a high level of psychological distress