From: The ongoing impacts of hepatitis c - a systematic narrative review of the literature
Category | Findings |
---|---|
Transmission | · Strongly associated with injection drug use – likely to occur early in injecting career. |
· Maternal transmission associated with hepatitis C viraemia – more frequent in maternal HIV co-infection. | |
· Prisoner populations at enhanced risk for infection. | |
Natural history | · Chronic infection can progress to fibrotic changes and development of liver cirrhosis, development of hepatocellular carcinoma (HCC) and increased liver-specific mortality |
· Complications of chronic infection predicted by persistent viraemia, moderate to high alcohol consumption and increasing age. | |
· Liver cirrhosis and HCC occur in persistently low serum alanine amino transaminase (ALT), but frequency and rate of disease progression low relative to consistently high serum ALT. | |
· Hepatitis B co-infection associated with greater incidence of HCC and lower survival than mono-infection with either virus. | |
· HIV-HCV co-infection found to accelerate progression to AIDS, end stage liver disease and liver-related death (mostly due to HCC). | |
Health related quality of life (QoL) | · Relatively consistent evidence of reduced QoL in untreated hepatitis C in most populations. |
· Variation among studies about the relative impact of a range of co-factors on QoL, although disease activity found to be independent of QoL. | |
· Interferon-based treatments associated with further reductions in health related QoL, with depression playing a significant role. | |
· QoL improves post treatment – particularly if sustained viral responses achieved. | |
· QoL benefits of successful treatment can be sustained over time (possibly the deleterious effects). | |
Health outcomes after antiviral treatment or liver transplant | · In most populations, including IDUs, sustained viral responses attained from 20% to 80% depending on viral genotype (types other than 1 and 4 considered the most favourable). |
· Sustained viral response associated with lower incidence of complications (e.g. HCC and death). | |
· Hepatitis C associated with lower survival and reduced overall health and function in organ transplant patients. | |
Psychosocial experience of living with hepatitis C infection | · Diagnosis with hepatitis C reported to have profound impacts on social function. |
· Perceived stigma led to high levels of anxiety and over-inflated assessments of transmission risks. | |
· Fatigue the most common symptom reported, followed by depression and other mental health issues, and myalgia. | |
· Symptoms independent of disease activity or disease severity, but reported to be associated with depression, anxiety and other psychosocial factors with some biological mechanisms proposed. | |
Responses to diagnosis and management of hepatitis C | · Diagnosis with hepatitis C often reported to be a stressful event, potentially mediated by personal and social context. |
· Perceived discrimination reported in multiple settings, including in interactions with health care services. | |
· Potentially a barrier to health service access and treatment | |
 | · Fear of side effects reported as a major influence on treatment decisions. |