Patient-reported Outcomes in Patients Chronic Viral Hepatitis Without Cirrhosis

The Impact of Hepatitis B and C Viral Replication

Zobair M. Younossi; Maria Stepanova; Issah Younossi; George Papatheodoridis; Harry L.A. Janssen; Kosh Agarwal; Mindie H. Nguyen; Ed Gane; Naoky Tsai; Fatema Nader


Liver International. 2019;39(10):1837-1844. 

In This Article

Abstract and Introduction


Background & Aim: Chronic infections with hepatitis B or C (HBV and HCV) are associated with adverse clinical outcomes and patient-reported outcomes (PROs). The aim is to compare PRO scores in patients with chronic HBV and HCV without advanced liver disease before and after suppression/clearance of their infection.

Methods: Patients with HCV and HBV infection prior to initiation of antiviral treatment and after viral suppression/eradication completed PRO questionnaires.

Results: We included 132 patients with HBV and 132 matched patients with HCV. Baseline PRO scores were significantly higher in patients with HBV in the domains of Physical Functioning, Role Physical, Bodily Pain, Social Functioning, and Role Emotional of SF-36, SF-6D utility, Emotional and Fatigue domains of CLDQ, Presenteeism and total Work Productivity Impairment of WPAI:SHP in comparison to patients with HCV by 5.8%-13.2% of a PRO score range (all P < 0.05). After viral suppression (HBV DNA < 20 IU/mL after 48 weeks of treatment for HBV) or eradication (SVR-12 for HCV), only Physical Functioning and Role Physical scores remained higher in HBV by 6.7%-9.9%, while other PRO scores became similar between HBV and HCV groups (P > 0.05). The most prominent improvement of PROs in HCV was noted in Vitality, Emotional, Fatigue and Worry domains. In addition, General Health, Worry and Work Productivity scores were the most improved in HBV.

Conclusions: Prior to treatment, PRO scores were lower in patients with HCV in comparison to HBV. After successful treatment, both groups of patients experienced improvement in some PRO domains confirming the positive impact of treatment.


Chronic liver disease (CLD) and its complications have been recognized as major causes of mortality and morbidity worldwide.[1] In addition to its clinical impact, CLD is responsible for severe impairment of health-related quality of life (HRQL) and other patient-reported outcomes (PROs).[2,3] Furthermore, CLD accounts for substantial health care resource utilization making it responsible for tremendous economic burden to the society.[4–7] It is important to note that comprehensive assessment of the true burden of any chronic disease, including CLD, requires accounting not only for its clinical aspects but also for its impact on HRQL as well as its economic and other non-medical consequences.[8] Given that, the combination of clinical and quality-adjusted outcomes accompanied by the costs of delivering these outcomes form the basis of value-based health care that is rapidly becoming the focus of health care delivery in different countries.[9]

Among a number of aetiologic causes of CLD, chronic hepatitis B (HBV), hepatitis C viruses (HCV), alcoholic (ASH) and non-alcoholic steatohepatitis (NASH) are the most important drivers of the global burden of CLD at present.[1,10,11] Although there is a great deal of data describing the clinical impact of these diseases, the impact of CLD on PROs is less well described. This is especially true for HBV which is the most important driver of liver disease and hepatocellular carcinoma in certain parts of the world.[11–13] As a result, in contrast to substantial evidence supporting the positive effect of HCV viral eradication on PROs,[14–16] similar data about HBV and the consequences of its suppression in terms of HRQL and other PROs has only recently started to occur.[17,18] Our aim was to compare PRO scores between HBV and HCV patients before treatment initiation and at the time of full HBV viral suppression or HCV viral eradication.