What do we want to know?
Hepatitis C (HCV) is a viral condition that can be acute or chronic and is mainly transmitted via infected blood directly entering the bloodstream. Infection typically results in chronic liver inflammation (hepatitis) but the consequences of contracting HCV are wide-ranging and can have a marked effect on the health of infected individuals. Some people infected with hepatitis C virus (HCV) will go on to develop extrahepatic conditions. To inform policy and practice relating to people in the UK living with chronic HCV, we undertook a systematic review to understand the relationship between HCV infection and subsequent extrahepatic conditions and the impact of these conditions on the quality of life in those people living with HCV.
Who wants to know?
Most people infected with HCV in Britain acquire the virus through unsterile drug injecting practices; however during the 1970s and 1980s, an estimated 32,500 people in the UK were infected following blood transfusion or other medical procedures. Since 2004, those surviving patients who acquired chronic HCV infection as a result of receiving contaminated blood products have received financial support via the Skipton Fund. This provides those patients infected with chronic HCV through NHS blood products with financial remuneration, reimbursement for the cost of prescriptions. This review was commissioned to inform policy decisions related to the Skipton Fund. It will be of interest to patients and their families, clinicians working in related fields, health researchers, and health policy advisers.
What did we find?
Of 194 extrahepatic conditions identified in the literature, depression, anxiety and pain were among those most often identified by advocacy groups as impacting on quality of life. The overall methodological quality of studies investigating the relationship between these conditions, quality of life and HCV was not strong across these topics. Findings from 22 studies provided promising evidence that people with HCV had a poorer quality of life than ‘general’ or ‘healthy’ populations, and that people co-infected with HCV and HIV had worse quality of life than people infected with HIV alone. Findings from 22 studies examining the association between depression and/or anxiety and HCV indicate that people living with HCV are approximately three times more likely to be depressed than those without HCV. Further, depression and anxiety are statistically significantly likely to be more severe in those with HCV than in those without. Findings from 26 studies examining the association between pain and HCV indicate promising evidence HCV is associated with an increase in the prevalence of fibromyalgia and arthralgia, and tentative evidence of no association between HCV and arthritis.
What are the conclusions?
The findings from this systematic review suggest that there is an apparent set of links between HCV, depression, anxiety and quality of life that merits further research and consideration by professionals working with people infected with HCV, as well as with patients in whom HCV may be a potential diagnosis. For example, counsellors might use these findings to recognise the potential need for increased support to cope with these extrahepatic conditions and tailor advice and referrals accordingly.
How did we get these results?
A systematic review of all extrahepatic conditions was undertaken, and 194 extrahepatic conditions were identified and mapped into a framework based on the number of studies for each condition. The perspectives of various stakeholder groups informed the scope and methods of this review: advocacy groups and key professional experts were consulted on a group-by-group basis to provide information about which conditions are most commonly experienced and how these conditions might impact on quality of life. The views of the advocacy groups were mapped onto the framework of extrahepatic conditions, and those conditions most frequently identified across stakeholder groups with the most published research were synthesised using meta-analysis and narrative synthesis methods.
The EPPI-Centre reference number for this report is 2301. This report should be cited as:
Brunton G, Caird J, Sutcliffe K, Rees R, Stokes G, Oliver S, Stansfield C, Llewellyn A, Simmonds M, Thomas J (2015) Depression, anxiety, pain and quality of life in people living with chronic hepatitis C: a systematic review and meta-analysis. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.